I am a PT and work with mobile healthcare delivery companies on policy and processes. So many companies hate hiring PTs because we are subject to so many more rules than other providers. I think some administrator in 1999 had it out for PTs when they required the nursing facility to submit all PT related billing even if they had someone else perform it.
The specific references in the claims processing manual seem to acknowledge the insanity of this, but don't seem to care that it impacts care. Home health and mobile care companies just run away when they find out that they need to bill the nursing facility and rely on them to bill Medicare.
The wildest thing is they attach this wild rule from 27 years ago and the days of physical fax relaying all billing to everyone. On the basis that "receiving faxes from multiple parties regarding care was confusing"
Visiting physicians can bill for all of their services separately. Except if it is this list of PT codes. Then they would need to bill through the facility. Even in a POS 32.
It's wild. I explain part b consolidated billing to business people and they just decide that it is impossible. They do not see nursing homes as reliable financial intermediaries.
Then the kicker is that if the company does decide they want to try. The nursing homes then negotiate a ridiculous "administrative fee" for the billing service, using this rule to essentially receive kickbacks for referring out. (I've seen companies agree to up to 50% of the billed rate being retained by the nursing facility).
By the way this is why all visiting physicians and NPs/PA refer to even the most rudimentary of selective debridements as a surgical debridement. Because 97597/8 are PT codes and they can't bill Medicare part B directly.
Rant! We need to scrap the rules and rebuild with a modern vision of what professions can do.