Please note that this article contains information that is only relevant to American clinics.
Many healthcare professionals providing treatment in Medicare patients’ homes have questions about whether or not insurance carriers will reimburse them under their outpatient therapy benefits. However, this is somewhat of a grey area as the rules surrounding outpatient therapy in patient homes vary from state to state, and payor to payor. In this article, we’ll be talking about the nuances of providing outpatient therapy in patients’ homes.
The Medicare program clearly states that therapy services are payable when a provider treats outpatients in their homes. The payable rates are even the same as the rates for treatment performed in the clinic or another outpatient setting. But, things get a little trickier when it comes to private practice physical therapy assistants (PTA) and private practice occupational therapy assistants (OTA) providing treatment in the patients’ homes.
If it were a PTA or an OTA from a hospital’s outpatient department, or a home health agency, the therapy assistant could perform the treatment without a hitch. It’s only in the case of private practice facilities that things become a little trickier.
While the CMS states that private practice PTAs and OTAs can in fact provide treat patients in their homes, this rule varies from state to state. As such, it is imperative that you refer to your state practice act to determine whether or not you’ll be able to send your PTAs and OTAs to treat patients in their homes. In some cases, state practice acts require the managing PT or OT to supervise the treatment—or at the very least—be present in the same physical location (i.e. the same building).
Fortunately, most insurance carriers will reimburse private practice PTAs and OTAs for services provided in patients’ homes. But either way, the clinic need only indicate where the treatment was provided using the relevant “place of service” code.
All said, it is clinic’s responsibility to consult both the insurance carriers and their state practice act to determine whether they will be able to send their PTAs and OTAs to patients’ homes on their own.
We hope you found this article helpful. For Medicare-related content, be sure to check out Gawenda Seminars and Consulting.