There is no limit to the amount Medicare pays for medically necessary outpatient physical therapy services in a calendar year. This comprehensive guide will discuss everything you need to know about Medicare home health coverage and its implications for physical therapy practices. If you choose Original Medicare (parts A and B), you may consider purchasing a separate Medicare supplement plan to help you pay for out-of-pocket expenses, such as deductibles, copays and coinsurance. Understanding the complexities of Medicare home health care is critical for physical therapy professionals who want to provide the best care while ensuring that their patients receive the maximum benefits.
Before you start getting home health care, the home health agency must tell you how much Medicare will pay. Medicare's payment for home physical therapy services is based on a prospective payment system, meaning that there is a predetermined base payment according to a classification system for services in the case of home health care, the model of patient-based groupings. The benefits of Medicare home health care services will not change, and the pre-application review process should not delay access to home health care services. By virtue of this demonstration, your home health care agency can submit to Medicare a request for a review prior to the application for coverage of home health services.
If you receive your Medicare benefits through a Medicare Advantage (Part C) plan or another Medicare health plan, check with your plan for more information about your home health benefits. Medicare home health care refers to medical services provided in a patient's home to treat injuries or illnesses. Before providing you with any service or supply that Medicare doesn't cover, the home health care agency must send you an advance notice of lack of coverage (ABN) for the beneficiary, including the items or services that Medicare may not pay for, the estimated cost of those items and services, and the reasons why Medicare may not pay for them. The agency must also tell you (both verbally and in writing) if Medicare won't pay for the items or services it provides and how much you'll have to pay for them. There's no limit to how much Medicare can pay for outpatient therapy services in a calendar year, as long as your doctor or other healthcare provider certifies that it's medically necessary.
