Hiccup in Home Health

After much wrangling, convincing, and talking with multiple individuals, dad finally received some of his physical therapy sessions through a home health agency while he was enrolled in hospice. The hospice agency had refused to authorize physical therapy sessions, stating erroneously that dad would have to be dismissed from hospice in order to have home health services. I did my best to prove this was not the case and gave reasoning why: the condition he had been hospitalized for was unrelated to the condition under which he qualified for hospice. One condition is acute, the other is chronic.

As mentioned previously, I finally located a home health agency who agreed to provide the hospital physician’s orders for PT. The agency stated my reasoning was correct; he could have both hospice and home health PT. Dad had 5 weeks and one session of his physical therapy before the agency called and said his PT would be discontinued as Medicare would not pay for it. What?? The issue had to be how the billing person coded the care. I called the office manager, and she was curt. “Our billing department knows what they’re doing and I’m sure they know how to bill it to Medicare. Your father received almost all his sessions. We also received notification Medicare will no longer accept these types of claims.” I waited a few weeks, did some research, and called her back.

Again, she was not the friendliest flower in the garden. I mentioned that I was NOT asking for further sessions, that I just thought the agency should be PAID for the services they provided to my dad. A slight change in her voice indicated I was making some headway. She took down the information I gave her: the home health agency must bill their services by including condition code 07, treatment of a non-terminal condition for hospice patient, or the claim would be automatically denied. She said she would check with her administrator and billing person and get back to me.

In the meantime, I called the Director of Marketing for the home health agency to let him know what was transpiring. We were still discussing changing hospice agencies. The only reason we didn’t want to switch agencies was for the home health aide that came three days a week to help our private caregiver shower dad. She is that good with him. Dad lets her shave him, do his nails, etc. It’s quite an amazing thing to watch. He’s so calm with her—there’s an element of unspoken trust there. The director said good home health aides are hard to find. If I got a chance, could I provide her with his contact information to see if she was interested in changing companies? That would solve lots of issues—and we could switch agencies and resume the PT services that had benefited dad tremendously.

I wish this story had a different ending than what transpired. The marketing director never called the home health aide. When I followed up, he gave me the reason that their hospice numbers were down, and it would be a few weeks (or months) until they could hire her. They never did.

Have we switched agencies? No. The HHA continued to provide quality care for us until recently, when she decided to quit the agency and take private pay clients. She continues to provide the very best care for dad when we schedule her and pay out of pocket. Some individuals should be cloned so they can share their talents with so many others.

By the way, the lady of the home health agency never called back about the billing or getting paid. And, as of this writing, Medicare continues to pay in these situations if billed with the correct code. Several months later we received an explanation of benefits showing they were indeed paid in full for the PT services they had provided. The lesson here? Be persistent and do your homework. If you do not ask, you won’t know what is possible.