Can a Patient Receive Therapy at More Than One Location?
As some physical therapists, occupational therapists and speech-language pathologists continue to specialize in the services they provide, a question I am often asked is do insurance carriers, especially the Medicare program, allow a beneficiary to attend therapy (same discipline or different disciplines) at more than one location during the same time period and reimburse both locations for the services they provide?
Let’s answer this question!
The Medicare program
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All material posted on our website is the intellectual property of Gawenda Seminars & Consulting, Inc. and can’t be used, reproduced, or posted as your own material without the prior written approval of Gawenda Seminars & Consulting, Inc.
This article is not intended to and does not serve as legal advice or as consultative services, but is for general information purposes only.
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What about patients receiving outpatient ST services and Homehealth PT/OT when the surrounding HHC agencies do not offer ST?
Please read this article: https://gawendaseminars.com/outpatient-therapy-and-home-health-services-at-same-time/
You state “or in their home”. Has something changed? I thought Medicare would not pay any OP therapy if the beneficiary had an open home care episode.
Thank you.
Susan
“or in their home” is the Medicare beneficiary receiving outpatient therapy in their home.
I understand the above scenarios. What about a patient receiving physical therapy at Clinic A for their knee and receiving physical therapy at Clinic B for their knee at the same time? Not a transfer of care, literally at the same time depending on which clinic they happen to be near that week.. I live in a high retirement area where people have 2 homes….one here and one in another city that they go back and forth in between. I’ve been asked to do this multiple times. I have always declined for clinical reasons but curious if it would even be reimbursable from either Medicare or other insurances.
Thanks.
The Medicare program would not prohibit that. With all the other insurance carriers, one thing to consider is whether prior authorization is required or not.
Sorry, late to this conversation but I want to clarify as I have similar issues with 2nd homeowners wanting to have care in two clinics at the same time. They want to receive 2 weeks care with us and then 2 weeks at their primary home. Back and forth monthly at times. It was my understanding that Medicare would not allow 2 open encounter of the same discipline whose dates of registration to discharge overlap. So in order to be seen at 2 different clinics and receive payment for services from Medicare each clinic would have to close their encounter (if you bill recurring encounters) when the patient leaves the area and then open back up a new encounter (and make sure the other location closed their encounter) when then returned to the area. Is this no longer the case. If so it would radically change how we can practice in my hospital.
Same answer that is in the article.
We have received denials based on overlapping dates of service in 2 clinics from Medicare(plans of care over lapping – not actual same dates of service) but you are saying they should reimburse for this?
CMS does not prohibit a Medicare beneficiary from receiving outpatient therapy at more than one location.
Does Medicare allow for a therapist to work and see patients in an outpatient setting and also to go to a patients home to perform outpatient therapy IN the patients home? Does the therapist have to be credentialed as one or the other or can they do both outpatient clinic setting and IN HOME outpatient visits?
The Medicare program pays for outpatient therapy provided both in the clinic setting and the beneficiaries home.
Thank you. One therapist can provide treatment in both environments correct? For example work 9-5pm in clinic and on their way home, treat a patient in their home. Also, any restriction on billing? Modifiers required?
If you require consulting services, I do offer them ad can address all of your questions. You can also read this article: https://gawendaseminars.com/coronavirus-and-therapy-in-the-home/
Hi Rick, thank you for this post. One thing I am running into are private insurers not allowing PT visits to the home (non-home health agency/private practice). It seems that about half of private insurers do, half don’t, and some won’t exactly specify when I call them.
Recently a Medicare advantage plan in our area told me that if I am in network with them they don’t allow it, yet they “follow Medicare guidelines” regarding coverage.
Is this a common issue across the country? Any insight?
Unfortunately, many insurance carrier phone representatives do not understand the difference between home health therapy and outpatient therapy provided in the home.
Thank you so much Rick. Do you think it is a simple issue of the phone representative or manager not understanding the difference or do many have formal policies against this? I am asking as I have spent hours on the phone trying to get answers and read many policy manuals… I just don’t want to start doing a lot of home visits and then get denials. I have a colleague in another state who has a mobile practice and he said that he hasn’t had any issues with denials.
If this is a complex answer, maybe I can setup a consulting session with you as with my older adults, Medicare is clear, but private insurance and Medicare Advantage Plans it isn’t clear.
I have not seen any major insurance carriers have policies that prohibit OP therapy in the home.
Can a patient be seen at clinic A and B for physical therapy services for different conditions the same day?
Yes, no, maybe so, depends. It could depend on the insurance carrier.
Thank you for this information Rick. Do you have a Medicare policy reference for this? I would like to be able to make this case to other practitioners in my area.
This is not in writing from CMS as well as CMS does not have in writing that this can’t occur.