In Home Physical Therapy

[Anonymous]

Has anyone used any In Home PT services without going through insurance? Any recommendations? Medicare isn't covering my mother's physical therapy anymore because they don't see any improvement but she desperately needs it. So we're willing to pay out of pocket. Thanks.

[Anonymous]

Following. A friend's DW is in a similar position after a stroke.

[Anonymous]

You could convince one of their old in-office PTs that you liked to come to the house and just pay them cash. I have a PT friend who has one client she has been seeing for years, about 2-3 times a month or so.

Another option would be Luna--visits are 125$ cash.

[Anonymous]

PT Post might work if you're in Montgomery County https://personaltrainingpost.com/

[Anonymous]

Medicare is not supposed to deny outpatient therapy because the patient has plateaued. https://hurleyeclaw.com/skilled-nursing-cant-end-because-youve-plateaued/ describes this issue (don't be dissuaded by the title--as the article says, it's true for skilled nursing, but also for outpatient therapy). You may have appeal rights.

[Anonymous]

Anonymous wrote:Following. A friend's DW is in a similar position after a stroke.

How long did they give her before deemed her plateaued? How long before denied PT?

[Anonymous]

Anonymous wrote:Medicare is not supposed to deny outpatient therapy because the patient has plateaued. https://hurleyeclaw.com/skilled-nursing-cant-end-because-youve-plateaued/ describes this issue (don't be dissuaded by the title--as the article says, it's true for skilled nursing, but also for outpatient therapy). You may have appeal rights.

This! I have also been told the first two appeal denials are basically routine. The third one is the one that might be taken seriously.

[Anonymous]

Wow, I wasn't aware of this rule. Thank you so much. We will definitely appeal. This seems to happen to us every few months, so the ability to actually improve is impossible.

[Anonymous]

Anonymous wrote:Medicare is not supposed to deny outpatient therapy because the patient has plateaued. https://hurleyeclaw.com/skilled-nursing-cant-end-because-youve-plateaued/ describes this issue (don't be dissuaded by the title--as the article says, it's true for skilled nursing, but also for outpatient therapy). You may have appeal rights.

This is interesting. I'm an outpatient PT, and we are always told we have to justify the need for skilled care in our documentation. We take that to mean that if anyone could supervise the exercises that we are doing with the patient/the patient can do them on their own, and it doesn't require my expertise, we have justification to discharge the patient. Absolutely we agree that most patients need to keep doing exercises after discharge, it's just means on their own, not with formal PT. Once we hit the outpatient Medicare cap we have to bill with a modifer that tells Medicare that we have gone over 18-20 visits for the year at which point they may start auditing the notes and decide not to pay. Usually this is after we have already seen them a bunch more times already. Like it or not, patients have to do exercises at home on their own, consistently, and push themselves for any appreciable change, even with regular PT office visits. This is difficult for many many people (of all ages and issues).