Page 231 - Medicare Benefit Policy Manual

• In certain settings and under certain circumstances, hospitals may not bill
Medicare for therapy services as services of the hospital:

○ If a hospital sends its therapists to provide therapy services to patients of
another hospital, including a patient at an inpatient rehabilitation facility
or a long term care facility, the services must be furnished under
arrangements made with the hospital sending the therapists by the hospital
having the patients and billed as hospital services by the facility whose
patients are treated. These services would be subject to existing hospital
bundling rules and would be paid under the payment method applicable to
the hospital at which the individuals are patients.

○ A hospital may not send its therapists to provide therapy services to
individuals who are receiving services from an HHA under a home health
plan of care and bill for the therapy services as hospital outpatient
services. For patients under a home health plan of care, payment for
therapy services (unless provided by physicians/NPPs) is included or
bundled into Medicare’s episodic payment to the HHA, and those services
must be billed by the HHA under the HHA consolidated billing rules. For
patients receiving HHA services under an HHA plan of care, therapy
services must be furnished directly or under arrangements made by the
HHA, and only the HHA may bill for those services.

○ If a hospital sends its therapists to provide services under arrangements
made by a SNF to residents of the Medicare-certified part of a SNF, SNF
consolidated billing rules apply. For arrangements specific to SNF Part A,
see Pub. 100-04, chapter 6, §10.4. This means that therapy services
furnished to SNF residents in the Medicare-certified part of a SNF cannot
be billed by any entity other than the SNF. Therefore, a hospital may not
bill Medicare for PT/OT/SLP services furnished to residents of a
Medicare-certified part of a SNF by its therapists as services of the
hospital.

NOTE: If the SNF resident is in a covered Part A stay, the therapy services would be
included in the SNF’s global PPS per diem payment for the covered Part A stay itself. If
the resident is in a noncovered stay (Part A benefits exhausted, no prior qualifying
hospital stay, etc.), but remains in the Medicare-certified part of a SNF, the SNF would
submit the Part B therapy bill to its A/B MAC (A).

SNF Setting Applicable Rules