An Overview of Home Health Outpatient Therapy

Author: Paul Singh

Did you know that Home Health Agencies (HHAs) have the ability to bill Medicare for outpatient services?

This is a relatively new trend that could have a big impact on HHAs in two ways:

  1. If a homebound patient has improved to a level where they no longer need inpatient care, the patient doesn’t need to discharge the patient, but rather retain them as a revenue source by continuing to provide care with a goal of improving or maintaining their status. This is less expensive than having to add the cost of constantly attracting new patients.
  2. It benefits the patient in the long run. If the HHA continues to provide outpatient services after the patient is no longer homebound, that patient is much more likely to reach their mobility goals.

However the rules can be somewhat confusing when it comes to this special type of outpatient billing. In this article, we’ll try to explain the ins and outs of home health outpatient therapy.

The first question to ask is if the Beneficiary is under a home health plan of care. HHAs may only bill Medicare for outpatient services if the patients are not homebound or are not receiving services under a home health plan of care (POC). This means that Medicare will not reimburse a patient’s outpatient Part B at the same time it is actively reimbursing that patient’s inpatient Part A claims. This cannot be stressed enough, verifying whether a patient is or is not under a home health plan of care will be critical for your success.

It is important to note that these services are not paid under the Home Health Prospective Payment System (HH PPS). So how does an HHA get reimbursed for home health outpatient therapy services? When an HHA submits an outpatient claim, the claim will be reimbursed per the Medicare Physician Fee Schedule at Part B rates, not Part A rates (Home Health Prospective Payment System). In other words, reimbursement would be paid at the same fee schedule as a local outpatient therapy clinic. Charging for transportation to and from the home is not allowed.

The biggest difference in providing in-home outpatient therapy services is how the agency or practice is credentialed.

The Home Health Agency and the individual providers must be credentialed with Medicare to provide services and bill under Part B. In contrast, Rehab Agencies (or ORFs) bill for Part B services under Part A.

Home Health Outpatient Therapy might just be what your HHA needs to weather the uncertainty of future events. However, just like everything else in the PT and OT realm, one must familiarize oneself with the myriad of guidelines and rules in order to determine if this route is right for your business.

If these rules and regulations seem daunting or confusing, StrataPT can help. Our knowledgeable representatives have the answers you need to grow your PT/OT practice and thrive in today’s economic environment. Please contact us today to schedule a free demo that will show you how to increase your profits through our revenue cycle management service.

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