Home Health OT vs OT in the Home: Differences in Billing and Practice

Welcome to The Amplify OT Podcast with your host, Clarice Grote—occupational therapist, founder of Amplify OT, and self-proclaimed policy nerd who actually enjoys reading the long documents most people avoid.

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Providing OT in the home or doing mobile outpatient has become so much more popular in the last few years, especially for individuals who are branching out into their own private practices. But if you’re working for one of these companies or considering starting your own, it’s important to understand the differences in billing and scope of practice between the two, as it greatly impacts patient care and reimbursement. That’s why this week on The Amplify OT Podcast, I am talking about home health OT vs OT in the home: key differences in billing and practice!

In this episode, I cover:

• The fundamental differences between home health (Medicare Part A, provided by home health agencies) and OT in the home (mobile outpatient, typically billed under Medicare Part B).
• Key eligibility and admission criteria for each setting, including what “homebound status” really means.
• How billing and reimbursement work, from value-based and bundled payments (PDGM for home health) to fee-for-service, timed codes, and considerations for cash-pay.
• The critical role of “qualifying services,” why OT isn’t currently considered qualifying under Medicare Part A, and important advocacy efforts to change this.
• Scope of OT practice in each setting—why home modifications and specialized services are more prevalent in mobile outpatient, and why home health tends to be more generalist due to payment structure.

Amplify OT Resources

Want to keep learning about how insurance and reimbursement impact you? Then head to AmplifyOT.com to check ‘em out!

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LINKS MENTIONED IN THIS EPISODE:

• Ep 11: Q&A: Is OT a Qualifying Discipline in Home Health
• Ep 9: Patient-Driven Groupings Model (PDGM) in Home Health
• Contact your legislator and ask them to pass the home health accessibility bill @ aota.org/takeaction
• Home Health Resources [Amplify OT]
• Can Occupational Therapists Opt Out of Medicare? [Amplify OT]

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