Create a win-win rehab contract for both sides
Create a win-win rehab contract for both sides
(Editors note: In this second part of a two-part series on contracts with outpatient rehab providers, we discuss specific items to include in your contracts. In last month’s issue, we discussed the issues that surround identification of patients for rehab and relationships with providers.)
The best way to make sure you maintain good relationships with rehabilitation providers in your area and ensure that everyone is properly reimbursed for therapy provided in an outpatient clinic or hospital outpatient department is to have a structured agreement in place before the patient needs a referral, explains Katie Riley, vice president of clinical for Advocate Home Health Services in Oakbrook, IL.
Items that should be addressed in your contract include:
• Identification of responsibilities
Even when the home health patient is in outpatient therapy, it is the home health agency that coordinates care, Riley points out.
Her agency contracts specify that the rehab provider must contact the home health case manager to discuss changes in therapy and also must report to the case manager either on a weekly or biweekly basis, depending on the patient’s status.
"One of our responsibilities is to continually assess homebound status as defined by Medicare to make sure the services will still be covered under the home health benefit," she adds.
If the patient’s homebound status changes, the agency discharges him or her from home health and lets the rehab provider know that the billing arrangement must be changed.
Documentation and fees
• Specific timeframe for documentation and billing
Rehab providers must provide a copy of their documentation before the bill will be paid, Riley says. "If charges on the invoice are not supported by the documentation we receive, we don’t pay them."
While Riley accepts copies of the documentation, Wanda Koerner, BSN, MS, administrator of Hays (KS) Home Health & Hospice Center, requires the original documentation. "Since we are the coordinator of care, we believe we should maintain the originals," she says.
Billing for rehab services in an outpatient clinic often is made in 15-minute increments rather than visits as in home care, Riley says.
Because therapy visits in outpatient can be counted as visits toward the service-utilization component of the home health-related group, you don’t want to count a 15-minute increment as a visit when you can count three increments as a visit, she explains.
This is allowed with Medicare’s definition of a therapy visit equating to 48 minutes, she adds.
You also want to make sure the rehab provider bills you in a timely manner, Riley adds.
"No one wants to handle a large bill submitted a year after service." Because many hospital outpatient therapy departments are slow to bill, be sure to accrue the charges and keep track of them as potential bills so you can plan on them arriving and not be surprised, she adds.
• Agreed-upon fees for services
Negotiating fees requires a good deal of planning and has to be done on a provider-by-provider basis, Riley says.
"I’ve used three different formulas for determining the fees I will pay," she explains.
Paying a percentage of charges is the easiest to manage, she says. If you choose this formula, make sure you know what the typical charge for the service is in your market as well as what your expected reimbursement from Medicare, Riley adds.
Other ways are to pay the Medicare allowable or a percentage of the Medicare allowable, Riley adds. These methods usually are more appropriate for smaller providers, she adds.
Whichever method you choose to determine fees, be sure you stay on top of typical charges in your market as well as Medicare allowables. Riley also recommends that you review your agreements on a regular basis to be sure fees are in line with current charges and allowables.
[For more information about rehab services under the prospective payment system, contact:
- Katie Riley, Vice President of Clinical, Advocate Home Health Services, 2311 W. 22nd St., Suite 300, Oakbrook, IL 60523.
- Wanda Koerner, BSN, MS, Administrator, Hays Home Health & Hospice Center, 2501 E. 13th St., Building 4, Hays, KS 67601. Telephone: (800) 248-0073 or (785) 623-5000. E-mail: [email protected].]
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