Since PDGM was announced, it took the home health community by storm. Under the new payment model, home health providers are expected to provide necessary services based specifically on patient illnesses, their clinical needs, any/all functional limitations, as well as safety and hospital readmission risks. All of this is used to make sure the patients stable, doing better, and remaining independent in their homes. The goal is to prevent them from frequent readmissions to a hospital or an emergency room. We must be realistic. It is completely inaccurate to think that a home health agency putting a limitation on therapy visits will not adversely impact the patients needs. Providers can not eliminate the need of services when assessments and functional impairment show it is needed.
So, what can we do? How can we as a home health provider find ways to diversify our services and increase revenue? One way is through outpatient part B therapy.
The biggest question I get asked is- “Will I have to apply for another certification?”. The answer is, No! This benefit is included in your original Medicare certification!
Many home health providers are unaware of the hidden opportunity that is outpatient Part B therapy. Therapy under a home health plan of care is included in your consolidated payment under Medicare Part A. However, outpatient part B therapy is billed and paid using the patients part B benefits. If a patient completes their home health episode and is not under a homebound status; the patient can still receive skilled therapy services (if needed) from the same agency. The reimbursement is calculated using the Medicare Physician’s Fee Schedule, the agency is reimbursed 80% of the allowable amount, and 20% is reimbursed by either supplemental insurance or the patient. The biggest thing to remember is that the patient must be totally released from Home health services. They cannot be receiving any services through that benefit.
There are a few potential reasons why outpatient part B therapy has not been generally sought-after in-home health. Numerous organizations do not comprehend the repayment and billing methods. This is because they are not quite the same as customary home health episodic billing. Home health agencies might be maintaining distance from providing this service because repayment depends on the Medicare Physician’s Fee Schedule. This fee schedule is undoubtedly lower than any normal episodic payment. Some organizations do not have their own therapists on staff. If therapists are contracted this service does not usually reimburse enough to offset their charges.
Patients receiving outpatient part b therapy must have Medicare Part B coverage. The services provided should follow Medicare guidelines for delivery of care. The patient must be under the care of a physician and a written Plan of care must be developed by the physician and signed by the physician. Unlike traditional home health, this Plan of care covers a 90-day span.
Are you having success with outpatient part B therapy? Bottom line a home health provider seeking a way to expand and diversify its service offerings should definitely explore outpatient part B therapy.
Give SMART a call today to sign up for our outpatient part B therapy training or our billing services. We look forward to working with you!