Question
Can a facility provide therapy under Medicare Part B at a frequency of 5 days a week, or is this considered a skilled service, and do you need to notify billing of a skilled "no pay bill"?
Answer
Yes, you can provide therapy at 5 days per week.
Yes, this is considered a skilled level of care.
You need to determine where the patient is within his/her spell of wellness.
Example 1: If the patient used 100 days of Medicare Part A and therapy began on Day 101, then a no pay bill is required. And this patient would be deemed at a skilled level of care for as long as therapy maintained a frequency of 5 days per week.
Example 2: If the patient has resided at the nursing home for a year and never accessed his/her Medicare Part A Benefit, the patient would be billed Medicare Part B and unable to access Medicare Part A unless the patient experienced a 3-night hospital stay within the last 30 days.
The answers to these questions become more complicated given the COVID Waivers.
HHI can help with Remote Medicare Case Management for these types of scenarios. There are multiple options and a variety of considerations that should be discussed in the context of qualify of care, reimbursement (both Medicare Part A and Medicaid Case Mix), and therapy service delivery.
Harmony Healthcare International (HHI) is available to help you proactively case manage your Medicare Part A caseload. The HHI team can perform daily, remote medical record reviews and provide your staff with the knowledge, tools, and research to effectively skill, document and code the documents necessary to bill for services rendered. If you are interested in HHI's medical record review services, click below to fill out a form and request an introductory phone call.
Harmony Healthcare International (HHI) is hosting our 9th Annual Long-Term & Post-Acute Care (LTPAC) Interdisciplinary Symposium Thursday, October 21st, and Friday, October 22nd, 2021 at the Encore Boston Harbor resort and casino. Click below to register and for more information!
