PHYSICAL THERAPISTFEESIN THEHOSPITAL SETTING

Any services the physical therapist performs at the hospital are therefore considered reimbursed within the percent of-charges method paid on hospital facility fees Therefore, the hospital cannot separately bill professional fees for physical therapists that are already reimbursed via the cost-based reimbursement on facility fees ? that would be double-dipping. Billing a professional fee for a physical therapist is different from billing a professional fee for an employed physician. CAHs cannot include the cost of ?Qualified Healthcare Professionals?that bill for direct patient care professional fees in the hospital cost report, which is the basis of the cost-based reimbursement for a CAH https://www ecfr gov/current/title-42/chapter-IV/subchapter-B/part-413/subpartE/ section-413.70

The following section from Title 42 of the Code of Federal Regulations explains that Medicare?s cost-reimbursement for CAH facility fees does not include the cost of ?physician services or other professional services to CAH outpatients ?

Payment for outpatient services furnished by CAH?

(1)

General.

(i) Unless the CAH elects to be paid for services to its outpatients under the method specified in paragraph (b)(3) of this section, the amount of payment for outpatient services of a CAH is determined under paragraph (b)(2)of this section.

(ii) Except as specified in paragraph (b)(6) of this section, payment to a CAH for outpatient services does not include any costs of physician services orother professional services to CAH outpatients.

The Medicare cost report work sheet A-8-2 ensures that CAHs do not ?double dip?? it ensures that the hospital cost report does not include the costs relating to professional services that are paid separately by insurers and the Medicare Physician Fee Schedule.

CAHs must separate the time the physician spends performing separately billable professional services from the time the physician spends performing non-billable duties. The hospital cost report can include an allocation of the physician?s employment cost for only that portion that is not attributed to performing separately billable professional services.