Can I Treat Patient’s in Their Home as an Outpatient

May 14, 2018
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Rick Gawenda
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Whether an insurance carrier will pay for therapy services provided in the patient’s home under their outpatient therapy benefits is the answer most people do not like; it is insurance carrier specific. Regarding the Medicare program, the Centers for Medicare and Medicaid Services (CMS) states therapy services are payable under the Medicare Physician Fee Schedule when furnished by a provider or supplier in the following settings:

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  1. Hello Rick;
    We have a patient who is currently receiving Home Care under Medicare Part B (through an agency not connected with our hospital) for a diagnosis of Parkinson’s disease. This individual also needs Lymphedema evaluation and treatment and would need to come to our hospital outpatient facility for this treatment. Can we bill Medicare B for the lymphedema services to be recevied at our hospital based outpatient center on a different day than the individual is receiving Med B physical therapy services in the home? Thank you.

    1. This would be considered a Medicare patient receiving outpatient therapy at 2 different facilities during the same time period. CMS does not prohibit this from occurring.

    1. There are no special modifiers required. On a 1500-claim form, the place of service code would be different.

  2. Hi Rick,
    We are currently seeing 1 visit(ortho bundle patients)through our home health agency and billing part A(which is a significant amount of work with the oasis for 1 visit) Is it possible to bill part b for that 1 visit(eval) through the home health agency? And if so do we have to get a part b number in home health or how does that work?

    1. The Medicare program does allow a Medicare beneficiary to receive outpatient therapy in their homes. All the rules and regulations are the same as if they came to an outpatient clinic or facility.

      1. I know that home health agencies have to obtain a face to face for their services. Do we as an out patient rehab facility billing part a, have to obtain a face to face or will we be alright with just the ordering MD signing the care plan?

        Thanks!

  3. “Additional expenses incurred by suppliers and providers of outpatient therapy due to travel to the beneficiary are not covered and are not separately billable to the Medicare program or the Medicare beneficiary.” – so a patient willing to pay travel fee could not simply sign an ABN? (or similar document for private ins)?

      1. Is it permissible to charge private insurance or Medicare advantage patient for travel time?

  4. Could you provide a link to the most current CMS supporting regulation? I have found the original 2004 reg but my CAH billing office says there is no reference they can find in the current CMS manual and believe the 2004 reg is no longer active. Thanks!

  5. Great info; thanks! Can a private outpatient practice bill Medicare B physical therapy for hospice treatment while the patient is receiving nursing care (Part A)?

    1. You would want to contact the Hospice agency as any rehab services would be delivered through Hospice.

  6. Hospital outpatient departments and home health agencies can treat Medicare beneficiaries in their home as an outpatient and submit those claims to their respective Medicare Administrative Contractor. Where is this regulation from your article stated? Thank you.

    1. CMS Publication 100-02, Chapter 15, Section 220.1.4. This is nothing new and has always been true.

      1. Thank you – I understand this would not apply to a Critical Access Hospital? Is that correct?

          1. Reading another one of your articles on “What is considered patients home” has a statement about CAH so that is why I was asking.

  7. For an outpatient private practice, do you have to be credentialed through Medicare for home visits in addition to the clinic location credential to be able to change the POS?