Home Health & Hospice Week

Remember: Examination equipment may be fixed, mobile or portable.

If your home health agency cares for patients who require dysphagia evals, be sure you're up on the feds' latest billing guidance for mobile MBS services--or you could wind up paying more than your fair share.

Basics: The Centers for Medicare & Medicaid Services recently clarified in the Medicare Benefit Policy Manual that modified barium swallow (MBS) tests may be administered using equipment that is "fixed, mobile or portable."

"This means that a provider may use mobile or portable equipment to provide these studies at nursing homes and in other non-hospital settings," points out Nancy Swigert, president of Swigert & Associates Inc. in Lexington, KY.

But who bills what can get tricky when you begin providing services offsite.

Sort Out HHA Applications

Billing basics: A hospital with its own staff using fixed (non-portable) MBS equipment would bill 92611 (Motion fluoroscopic evaluation of swallowing function by cine or video recording) for the speech-language pathologist's (SLP's) time, and then 74230 (Swallowing function, with cineradiography/videoradiography)--the technical component for the radiology tech and the professional component for the radiologist.

If hospital staff perform MBS procedures offsite, however, different rules apply. For example, if hospital staff bring portable MBS equipment to test a patient covered under Medicare's home health benefit, the hospital cannot bill SLP services directly to Medicare; the HHA does instead.

Rationale: Under Medicare Part A, speech language pathology is a covered home health service; therefore, the HHA is financially responsible for the SLP's time involved, explains Cindy Krafft, director of rehabilitation services for OSF Home Care, a six-HHA chain based in Peoria, IL.

In fact, Medicare will deny the hospital payment for the related speech language pathologist's services regardless of where a home health PPS patient receives the test. "It will be denied, no exceptions," Krafft stresses.

But to compensate for its staff's time, a hospital rehab department providing the MBS may opt to enter into a billing relationship with a HHA, negotiating an amount that the HHA will pay them for the test.

Red flag: If, however, you do not know about the test beforehand, you can refuse to pay, Krafft says.

OASIS tip: If a patient requires an MBS you can code OASIS item MO825 (Therapy need) as "1" (yes), but be sure to secure the needed supporting documentation.

"The visit does 'count,' but we have to have a copy of the order as well as the documentation to support the test on our charts," Krafft says.

Important: HHAs "are not responsible for the radiology or any other associated costs," Krafft clarifies.

Note: To read the full rules regarding your setting and billing for mobile MBS services, check out the Medicare Benefit Policy Manual, Sec. 230.6, page 153 of the PDF file at www.cms.hhs.gov/manuals/Downloads/bp102c15.pdf.