Medicare Compliance & Reimbursement

Feds pay heavy scrutiny to claims for concierge services.

More and more physicians have begun charging patients a monthly or annual fee for extra attention, and rehab providers are beginning to notice. But rehab providers should tread lightly if they think this is a good idea, because the feds are watching.
 
The feds have warned against so-called "concierge care" twice in recent years. In 2002, then-Health and Human Services Secretary Tommy Thompson wrote a letter to Rep. Henry Waxman (D-CA) explaining that physicians aren't allowed to bill Medicare patients for any services that Medicare might cover, notes John Marquis, an attorney with Warner, Norcross and Judd in Grand Rapids, MI.
 
Then, the HHS Office of Inspector General issued a fraud alert in March 2004 about "Added Charges For Covered Services." The OIG said it had alleged that a particular physician violated his assignment agreement by charging an annual fee of $600 for spending more time with patients even though Medicare was already paying for the visits.
 
The bottom line: If a provider charges a higher fee for extra time or attention, the service should be something that Medicare doesn't cover, explains  Wayne Miller with Compliance Law Group in Woodland Hills, CA. But experts disagree on what Medicare is and isn't paying for through its physician fee schedule.
 
Not covered: Clearly Medicare doesn't cover certain services - or doesn't cover them as adequately as it could. For example, when speaking of rehab providers' counseling or other wellness-type services, Medicare won't consider them medically necessary, Miller notes.   

Accordingly, providers rendering these services may wish to alter their fees to secure more acceptable payment. There's a slew of non-covered services that therapists may wish to charge for. For example, if a patient is admitted to the hospital, the "concierge" therapist may promise to come visit the patient in the hospital every day. Therapists can legitimately charge for these types of services, says Allan Jergesen, an attorney with Hanson, Bridgett, Marcus, Vlahos and Rudy in San Francisco.
 
Gray area: If a provider promises to provide more access to patients than a normal therapist would provide, it could be argued that Medicare doesn't pay for that service, says Miller. For example, a provider could charge for access via the Internet, or being directly available through the phone.
 
Also, a rehab provider could promise same-day appointments, returning calls within two hours, or being personally available via phone 24 hours a day. n