Home Heath

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  • 1.  "Outpatient" physical therapy

    Posted 02-26-2025 02:33 PM

    We have a wound care patient, with traditional Medicare, on service that lives in an upscale assisted living facility. Our nurse found out from the patient that he goes to PT every Tuesday/Thursday. Apparently, an independent therapy agency uses a spot in the assisted living to provide therapy services to their residents.

    I guess this wouldn't affect the patient's homebound status since it's provided in the ALF, but since he is on service with us, wouldn't the therapy agency have to contract with us to provide services if they want to be paid if he was on service with us first?



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    J Scott Lambert MPT, JD
    Director
    Washington Regional Home Health
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  • 2.  RE: "Outpatient" physical therapy

    Posted 02-28-2025 11:54 AM

    You are correct that the therapy agency won't get paid by traditional Medicare. They'll get a denial from Medicare for the services, then they will turn around and bill you for it. It will be up to your agency if you pay or not (you don't have to as you didn't contract with them for the services). But if they do contract with you, they can't do whatever they want – they need to adhere to the Medicare plan of care you developed and be a part of your care team.

     

    Beau Sorensen




    Original Message


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