Question: I find myself caught in the middle of a difficult situation regarding aquatic therapy, and I hope you can help. I work for a contract company that provides all of the services for our local hospital. We provide both inpatient and outpatient physical therapy, occupational therapy and speech therapy. All of our billing is done through the hospital's Medicare number. In turn, our company bills the hospital for our services. Therefore, our company does not bill Medicare directly for the services to patients.
As part of our service, we have been providing aquatic therapy at the local (offsite) YMCA for many years. We have recently been told that we can no longer provide the service to Medicare beneficiaries because of our status as a hospital provider that is under arrangement rather than as hospital employees. Most of the information we have found indicates that we can lease the space from the YMCA as long as the other requirements are met.
My understanding is that the state department of health needs to be aware of the service and check the pool policies and procedures as part of our survey. We have been surveyed by the state twice and JCAHO twice since starting the service at the YMCA, and they have never had an issue with the service that we provide, or the pool. However, someone in our company is interpreting the recent changes (June 9, 2008 Transmittal 88) as restricting us from providing the service to Medicare beneficiaries. They state that we could provide the service if the therapy staff were hospital employees, but because we are a contract service, we are prohibited from doing this for Medicare patients.
Can you lend some insight and/or opinions to our situation? I have more information if needed, but I hope this is complete enough.
Answer: The following is a quote from the IOM Pub.100.02 Benefit Policy Manual: Chapter 15 - Covered Medical and Other Health Services; §230.6 - Therapy Services Furnished Under Arrangements With Providers and Clinics, B. Special Rules for Hospitals: "A hospital may bill Medicare for outpatient therapy (physical therapy, occupational therapy, or speech-language pathology) services that it furnishes to its outpatients either directly or under arrangements in the hospital's outpatient department. If a hospital furnishes medically necessary therapy services in its outpatient department to individuals who are registered as its outpatients, those services must be billed directly by the hospital using bill type 13X".
As long as the contract with the YMCA to use the swimming pool is between the hospital itself and the YMCA, and the contract is not between your therapy company and the YMCA, and the contract indicates that the YMCA is used as an extension of the hospital facility, there should be absolutely no problem in providing aquatic therapy services to Medicare beneficiaries.
Pauline M. Franko, PT is owner of Encompass Consulting & Education, LLC; a consulting and education company specializing in Medicare Consulting, Compliance and Training, based in Tamarac, FL. The company's "Direction on Demand" service specializes in providing the rehabilitation professional with a clear, easy way to understand how to provide Medicare compliant services to their patients in the SNF and Outpatient settings. As an associate in Comprehensive Medicare Consultants, LLC, she is responsible for assisting with and directing compliance programs to Rehab Agencies. Danna Mullins is an associate and lecturer with Encompass. You may contact the authors through the Encompass website at www.encompassmedicare.com or by phone at 954-720-4087.