Can I charge for speech therapy under Part B?

1 answer | Last updated: Nov 02, 2016
A fellow caregiver asked...

I have been providing speech therapy services under Medicare Part B in an assisted living facility on an outpatient basis. My patient is going to a skilled nursing facility and receiving physical therapy. Can I still see and charge for my services under Part B? Someone mentioned "double dipping".

Expert Answers

Several different Medicare rules come into play in answering your question. First of all, if Medicare Part A covers the skilled nursing facility stay, all medically necessary inpatient services -- including speech therapy -- are usually provided by the facility itself and would be included in the daily facility charge paid by Medicare Part A. So, if the skilled nursing facility has its own speech therapist, and your patient's doctor continues to prescribe speech therapy for him or her, the facility will provide the therapy. If so, the facility probably wouldn't allow you to provide your services there, and if you did, Medicare Part B probably wouldn't cover it because the patient would also be receiving the same services from the facility. That's probably the "double-dipping" that you heard someone mention.

On the other hand, if your patient's doctor continues to prescribe speech therapy for the patient but the skilled nursing facility does not provide speech therapy, you might be permitted to provide services to your patient while he or she is in the nursing facility. If so, then your services could be reimbursed under Medicare Part B. Bear in mind, though, that Medicare's Part B yearly patient limit on payment for therapy is $1,840 for physical and speech therapy combined. If the physical therapy your patient is now receiving is part of the in-house services provided by the skilled nursing facility, that probably would not be billed separately to Medicare Part B but instead would be a part of the daily facility charge covered by Medicare Part A. If the physical therapy your patient's now getting is covered by Medicare Part B, however, the total amount Medicare Part B pays for that therapy is added to the amounts Medicare Part B pays you for the speech therapy, and all Medicare Part B therapy payments will stop when the Medicare Part B therapy total for the year reaches $1,840. When the new calendar year starts, though, a new $1,840 becomes available from Medicare.