Hospice and Outpatient Therapy
Lately, I have been receiving questions via email and on various social media platforms concerning providing outpatient therapy services to a Medicare beneficiary who is in hospice. What people want to know is does the Medicare program pay a therapy provider separately for outpatient therapy services that they provide to a Medicare beneficiary who is in hospice? Let me answer this question for you as well as several other questions related to this topic.
Question
Does the Medicare program pay a therapy provider for outpatient therapy services that they provided to a Medicare beneficiary who is in hospice?
Answer
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Question
Does the Medicare program pay a therapy provider for outpatient therapy services that they provided to a Medicare beneficiary who is in hospice if the reason for outpatient therapy is not related to their terminal condition?
Answer
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Question
Is there a modifier I should append to my CPT codes on the claim form to indicate the outpatient therapy services are not related to the Medicare beneficiaries terminal condition?
Answer
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Question
Is there documentation that is required that a hospice provider provide to the Medicare beneficiary regarding services that are not related to their terminal condition?
Answer
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Question
What if the Medicare beneficiary was enrolled in a Medicare Advantage plan prior to entering into hospice care? Would the Medicare Advantage plan pay the therapy provider for outpatient therapy services they provided to the beneficiary?
Answer
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Question
If I am providing outpatient therapy services to a Medicare beneficiary for a condition that is not related to their terminal illness or any related conditions, must I and/or can I issue the Medicare beneficiary an advance beneficiary notice of noncoverage (ABN) form?
Answer
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Question
Where can I learn more about hospice care under the Medicare program?
Answer
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I hope you found this article helpful and that you now have a better understanding of providing outpatient therapy services to a Medicare beneficiary who is in hospice. Thank you for being a Gold Member!
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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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Super helpful, thank you!!
What about a patient on Palliative Care? Can they receive out patient physical therapy? Dose Palliative Care follow the same rules as a patient on Hospice Care?
Palliative care is the part of hospice care that focuses on helping people who are terminally ill and their families maintain their quality of life so the beneficiary has selected hospice.
Palliative care can be provided without being enrolled in hospice and that would not affect the payment. I suggest investigating if it is palliative care only or also enrolled in hospice.
That is correct.
I’m an Occupational Therapist who’s opening a mobile outpatient clinic-business. Continuing self care and independence (ADL’s) is a huge factor for retaining quality of life for hospice patients. However, medicare can say that “anything” can be related to their terminal illness and wouldn’t the likelihood of denied claims be high in these situations? From an OT perspective, is there a way around this?
I have a patient who was just placed on hospice and the wife is refusing to use the hospice therapy. She wants to pay out of pocket for her husbands physical therapy at their house. I believe that medicare will say the therapy is part of his illness. He is 93 and just not getting around well. He needs balance and someone to help him move without falling, he is huge fall risk. Can I get an ABN and let them pay cash for this? Because I know medicare won’t cover my charges? Thanks
Not sure if this info is needed, but we bill part A medicare. Thanks
All outpatient therapy is paid under the Part B benefits. If you are not as private practice, you submit claims to the Part A Medicare Administrative Contractor who processes both Part A and Part B claims.
Due to liability reasons, I can’t provide consulting advice in this forum as there are several things to think about in the situation you describe.