Summary of replies for HHE Billing
Ryan Dougherty
Description
Collection
Title:
Summary of replies for HHE Billing
Creator:
Ryan Dougherty
Date:
6/23/2010
Text:
Here is a summary of the replies for my previous question regarding billing
for orthotic devices while the patient is receiveing home health:
-This issue goes back to Hillary Care and the wonderful 100 day rule. For
orthotic devices the nursing home is technically supposed to pay for
them...but they are also strapped for money and don't want to pay for them.
You really have to wait the time out until the patient is back on a part B
stay so that you can bill for it.
I know of some orthotists that will fit the device and loan it to the
patient until the clock runs out and then on day 101 they will finish the
brace and then deliver the brace and have the patient sign for it and then
bill it. But of course there are risks with that too...like the patient has
another medical issue and goes back into the hospital for a different
problem and start their nursing home stay again...or they might die before
the magic 100 day mark.
There really isn't any good safe way to get around this rule. This also
applies to stump shrinkers and socks from my experience...so beware of that
too. When I deliver a prosthesis to someone in a facility who is in a Part
A stay (under the 100 days) I only provide them with a couple socks and then
later on I will give them the rest and then bill for them. Just more hoops
and hurdles to deal with. Great examples of how government control of
healthcare isn't good for most patients.
-(From an AOPA representative) Orthotics and prosthetics is not a part of
the Home Health Prospective Payment system and as such, O&P is billable
directly to Medicare. The only catch is that CMS allows either the HHA or
the supplier to bill, but not both. If both bill, the claim that hits the
payment system first is considered the valid claim while the second one is
denied.
So it would be helpful to work out with your HHAs an agreement before you
provide care, to make sure that you can bill without duplicating their
efforts.
I've attached a couple of passages from the CMS Claims Processing Manual
concerning HHA services that you may find helpful.
I'll pass this same information on to Steve when I reach him.
-If covered by home health then they should pay you for needed services
-We just encountered this with a wound stocking. Apparently the
home health agency has to pay you just like a nursing facility with a pt
under part A stay.
From what I understand, we as O&P providers are expected to bill the HHA by
using a PO supplied by them. They will include the orthotic billing in
their claim during the billing process. Hope this helps.
Thanks for the replies,
Ryan Dougherty, CP
for orthotic devices while the patient is receiveing home health:
-This issue goes back to Hillary Care and the wonderful 100 day rule. For
orthotic devices the nursing home is technically supposed to pay for
them...but they are also strapped for money and don't want to pay for them.
You really have to wait the time out until the patient is back on a part B
stay so that you can bill for it.
I know of some orthotists that will fit the device and loan it to the
patient until the clock runs out and then on day 101 they will finish the
brace and then deliver the brace and have the patient sign for it and then
bill it. But of course there are risks with that too...like the patient has
another medical issue and goes back into the hospital for a different
problem and start their nursing home stay again...or they might die before
the magic 100 day mark.
There really isn't any good safe way to get around this rule. This also
applies to stump shrinkers and socks from my experience...so beware of that
too. When I deliver a prosthesis to someone in a facility who is in a Part
A stay (under the 100 days) I only provide them with a couple socks and then
later on I will give them the rest and then bill for them. Just more hoops
and hurdles to deal with. Great examples of how government control of
healthcare isn't good for most patients.
-(From an AOPA representative) Orthotics and prosthetics is not a part of
the Home Health Prospective Payment system and as such, O&P is billable
directly to Medicare. The only catch is that CMS allows either the HHA or
the supplier to bill, but not both. If both bill, the claim that hits the
payment system first is considered the valid claim while the second one is
denied.
So it would be helpful to work out with your HHAs an agreement before you
provide care, to make sure that you can bill without duplicating their
efforts.
I've attached a couple of passages from the CMS Claims Processing Manual
concerning HHA services that you may find helpful.
I'll pass this same information on to Steve when I reach him.
-If covered by home health then they should pay you for needed services
-We just encountered this with a wound stocking. Apparently the
home health agency has to pay you just like a nursing facility with a pt
under part A stay.
From what I understand, we as O&P providers are expected to bill the HHA by
using a PO supplied by them. They will include the orthotic billing in
their claim during the billing process. Hope this helps.
Thanks for the replies,
Ryan Dougherty, CP
Citation
Ryan Dougherty, “Summary of replies for HHE Billing,” Digital Resource Foundation for Orthotics and Prosthetics, accessed December 26, 2024, https://library.drfop.org/items/show/231657.
