HH/Outpatient PT

I can’t imagine why a person would want to do both Home Health and outpatient at the same time.

What a grind! PT and OT in HH Is enough.

Later on, do the other if needed.

I’m not surprised that the home health agency isn’t going to pay you, I don’t know of any that would. And I would imagine Medicare is going to ask why you at the outpatient clinic couldn’t address whatever this new issue was. Unfortunately, these kind of situations happen. That’s why I always asked what was going on with my clients, what medical appointments they’d had, etc. More than once, I was the HH clinician that figured out the patient had been admitted to hospice or was about to start outpatient. And yes, I would contact Medicare to discuss your option for billing.

I worked for Visiting Nurses. We had clients that once Homecare was in the picture, we did not see the patient. Two agencies cannot see the person at the same time. Now, we were non-profit so we did not bill anyway.

IMO, if Medicare is not paying you for the overlapping visits, then you bill the client. There must be a statement from Medicare saying why you are not being paid. But, I wonder, since the PT is for two unrelated problems, why would not Medicare pay? Maybe, because to get in home care you are not suppose to be able to be an outpatient?

I would call Medicare and run by them the care was for two different things and see what they say. If they stand by their guns, then you need to bill the client. In the long run its the clients fault for not telling you they had homecare. They are responsible for the visits with you. Hard lesson to learn. But homecare is done because the person cannot leave their home for outpatient care.

So it sounds like both the home health and outpatient PT services were paid and then the outpatient recouped, correct? If it’s just a few visits, I think it’s unlikely that the outpatient clinic would bill the patient, especially if they have a good relationship and want to continue providing services. Does the client have any cognitive issues?

You don't say how long this went on, but at some point, if this is an advantage plan, they are responsible to know what can and cannot be done.
I wouldn't worry this until and unless a bill shows up.
IF your elder is without funds, then do know that unpaid medical bills just pile on up. Medicaid, SS, SSDI is not funds that can be attached in any court action.

Then there's always a -- you know -- poor memory. As in "No one told me any such thing! That's a lie". In this day and age, with what is happening in medical care, pharmaceuticals, costs, Hospice being ground down to nothing much at all, my moral code is slipping. At 81 I "play it as it lays" to quote the late great Joan Didion.

I would take a wait and see on this one. Get back to us when chapter II arrives.

I'm not a medical billing specialist and by no means anywhere close to an expert when it comes to Medicare so that this with a grain of salt.

My assumption would be YES, the patient can be billed for the Home Health PT sessions and held responsible for payment of services rendered - because they consumed the services for both outpatient and in home PT and the resources for both must be paid by someone. The patient was advised not once but at least twice that they could not "double dip" but continued to utilize both services. Now Medicare has paid the outpatient service - but I'm assuming they will not pay the home health service because it was a double service. So, yes, the patient can (and should) be held responsible for paying that bill, especially given that they were aware that Medicare wouldn't cover both.