Medicare Compliance & Reimbursement

Before treatment begins, ask the patient if he is under HHA care already.

Therapists who treat home health patients when they start outpatient physical therapy may not get paid by Medicare any more. Therapists can try billing the HHA, but doing so probably won't do any good.
 
The regulations make very clear that agencies don't have to pay for services provided by a therapist who hasn't signed a contract with the agency, explains Burtonsville, MD-based attorney Elizabeth Hogue.
 
For an "arrangement" to be valid, the agency must be aware of the therapy you're providing, she says.
 
For example, therapists often send wound care patients to outpatient clinics for whirlpool therapy without the HHA's knowledge. In cases like this, the HHA isn't responsible for payment.

Therapists can usually stop this problem before it starts by finding out in advance whether a patient is under home health care. "Treat it as though it was any other kind of insurance situation," advises Cindy Krafft director of rehab services for OSF Home Care in Peoria, IL. Routinely ask patients if they're receiving home health, and if so, call the agency to discuss the situation.

Therapists also can check Medicare's common working file to see whether a patient is under home health - assuming the agency has submitted its information in a timely fashion. Query Patients Often About Home Health Therapists should not only ask whether patients currently receive home health - they should also ask whether they received these services in the recent past. If so, call the HHA to make sure it has discharged the patient from its system, counsels Debbie Griffin, director of rehab for Northwoods Lodge in Silverdale, WA.

Medicare considers a patient to be active under home health until the agency officially discharges him from its computer system - even if the agency no longer goes into the patient's home, Griffin emphasizes. As unfair as this may be, the therapy provider is "at the mercy of the timeliness of the HHA," Krafft continues.

Further, even if a therapist does his best to determine whether a patient is under home health and still winds up getting burned, there's not much he can do about the situation, experts agree.