Eli's Rehab Report

Question: A few of our Part B clients have asked to receive their outpatient treatment in their homes. We would like to accommodate their request, though our practice is not a home care provider. Can we set up this arrangement and bill the visit as outpatient?

Answer: Yes, "the Medicare program allows you to treat patients in their homes as outpatients," says Rick Gawenda, PT, president of Gawenda Seminars & Consulting in Detroit.

Providing therapy to patients in their homes is a "highly valuable service to the community," says Tom Howell, PT, MPT of Howell Physical Therapy in Eagle, Ind. At-home treatment is especially marketable for patients with acute severe back or neck pain that keeps them from leaving the house, he notes.

Not so fast: If patients are under a home health agency plan of care, you can't receive separate reimbursement, Howell says. For these cases, work with the agency to get the discharge done (and in writing) so that you can begin therapy.

If the agency is still treating the patient -- such as for clients who aren't homebound but need nursing services at home -- you can set up a contract with the agency that pays you out of their Part A reimbursement. However, this arrangement is tricky and can often leave therapists high and dry when it comes to payment, Howell warns.

Remember that Medicare doesn't reimburse for your travel time. Howell suggests scheduling at-home therapy for early morning or late afternoon sessions so your therapists can work with them on the way to or from work. And therapists should always carry a "travel kit" that includes everything they might need so that no one is traveling back and forth unnecessarily.

Important: While Part B pays for at-home outpatient therapy, you should still thoroughly document your reasoning for working with patients at home, Howell advises. You can simply jot down the problem, whether it's that a client doesn't have reliable transportation, is in severe pain that limits mobility, or another factor.

Bottom line: As always, check with applicable state laws and your conditions of participation, Gawenda stresses. If they say you're clear for at-home outpatient treatment, you can begin seeing patients in their homes immediately. Those using the 1500 claim form will simply choose place of service code 12 to signify the location.