A common question we hear at FeldCare is “What is the difference between home health therapy and outpatient in-home therapy?”
The terminology can be confusing, and therefore may make a physician or rehab center wonder if their patient qualifies for outpatient in-home, or if they would be better served with a home health referral.
It is vital for clinicians and medical practitioners alike to grasp the nuances of these models, particularly in the context of Medicare regulations, to effectively meet the evolving needs of their patients.
Home Health Therapy vs. Outpatient In-Home Therapy
Outpatient in-home therapy (PT, OT, or ST) differs from home health therapy in how they are billed. Additionally, outpatient in-home therapy is provided to those patients who are not homebound, but prefer to receive therapy in their home. No matter the label, all therapy is provided with the same quality and care.
Under Medicare guidelines, home healthcare is reserved for homebound patients requiring physical therapy (PT), occupational therapy (OT), and/or speech-language pathology (SLP) services, as certified by a doctor. Additionally, the patient must also have a plan of care created by their doctor. Any covered home health services are billed under Medicare Part A.
According to current Medicare rules for home health services, for a patient to be eligible to begin a home health plan they must be:
- Homebound;
- In need of skilled-yet-intermittent nursing, PT, OT, or SLP care; and
- Under the care of a physician.
In contrast, outpatient in-home therapy is reserved for patients who are not homebound but who prefer the convenience of receiving PT, OT, or ST in their home.
When it comes to Medicare patients, billing for these outpatient services falls under Medicare Part B, which can only be billed if the patient is not simultaneously receiving care under Part A. This applies even if the care being billed under Part A is for non-therapy services such as nursing.
This distinction highlights the specific criteria under which these services are provided and billed, ensuring clarity for both healthcare providers and patients.
Now that you understand the main distinction as established by Medicare, we hope you will explore FeldCare Direct to find options for concierge in-home outpatient services, and find out more about FeldCare Connects if you are home health agency looking for clinicians that can assist your patients in the home health space.
