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Medicare Compliance & Reimbursement

HOSPITALS:

When Hospitals Can Bill For Outpatient Therapy

Published on Thu Jun 03, 2004

Three scenarios clear the mark,CMS says.

Hospitals have long been confused as to when they can and cannot bill Medicare for services provided by their outpatient therapy departments.

The Centers for Medicare & Medicaid Services April 23 clarified the rules governing outpatient therapy billing in Transmittal 9. "If a hospital furnishes medically necessary therapy services in its outpatient department to individuals who are registered as its outpatients, those services must be billed directly by the hospital using bill type 13X or 85X for Critical Access Hospitals," the transmittal reads.

Here are the situations in which a hospital may bill Medicare for services provided to patients in a setting other than the hospital outpatient clinic, so long as the services meet the requirement applicable to outpatient hospital therapy services:

  • when a hospital sends a therapist to the home of a patient whose medical condition prevents him from traveling to the hospital for therapy services;

  • when a hospital sends a therapist to treat a patient residing in the non-certified part of a skilled nursing facility or in another residential setting; and

  • a hospital may make arrangements with an outpatient rehab facility or private practice (as long as the services also meet the requirements applicable to services furnished under arrangements).

    The complete transmittal is at www.cms.hhs.gov/manuals/pm_trans/R9BP.pdf.

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