Provider Terms and Conditions

Thank you for supporting HOMELINK, a division of VGM Group, Inc.

General Disclosures

Your service confirmation outlines the items you agreed to provide and the prices negotiated with HOMELINK. Any modifications to the order confirmation must be approved by HOMELINK prior to the provision of services. No written revisions by the provider will be accepted.

You agree to indemnify and hold harmless HOMELINK and Insurer/Payer from any and all loss, damage, or defense costs (including attorney and defense fees) arising in any way from actual and/or alleged wrongful acts or omissions of you as provider, your officers, employees, subcontractors or other agents, in performing services or providing products as contemplated under this agreement.

Billing & Claim Information

The sooner you submit your claim to us, the faster our claim can be expedited to the payer. We will pay your company when we receive reimbursement from the payer unless your contract specifies otherwise.

Submitting your claim to HOMELINK

Please submit your claim on a proper CMS-1500 form, regulated by Medicare/State Guidelines, which includes the following:

• Patient name
• Patient SSN
• The HOMELINK order number
• Your federal tax ID number
• Your remit address
• A signed letter or certificate of medical necessity from the physician if you have it

Additionally, please send us:

• The letter or certificate of medical necessity – we must have this to submit the claim to the payer.
• A signed patient delivery ticket – some payers require this document.

We may ask for your assistance in obtaining the medical necessity information from the physician. 

TRANSPORTATION PROVIDERS: please note the billing terms specific to your services noted here.

Electronic Claims

Submitting your claims electronically is the fastest method to receive payment.

• Smart Data Solutions (SDS): our payer ID is 30750
• Change Healthcare: our payer ID is 50701

Paper Claims

Mailing address: HOMELINK, PO Box 211490, Eagan, MN 55151

Fax to: 877-786-6579

Email to: GetYourBillToUsFast@vgm.com

Claim Status Information

Check the status of your claims in our Provider Portal: https://www.vgmhomelink.com/member/login

Additional Billing Disclosures

You must bill HOMELINK for all services rendered in your service confirmation to secure payment.  Please notify your billing department that all claims must be sent to HOMELINK by any method noted above. DO NOT CALL OR BILL THE PAYER DIRECTLY. This could result in a reduction of benefits to the patient or a zero payment to you.

By accepting referrals from HOMELINK, you acknowledge and accept that any direct contract you may have with the payer or PPO network involved with this referral is superseded by this agreement.

You agree to accept reimbursement provided on your order confirmation as payment in full for all services provided to the patient and not balance bill the patient for any balance due.

There may be occasions when the patient referred has been involved in a motor vehicle accident. Claims may be delayed in these situations due to subrogation.

HOMELINK is not an insurance company. HOMELINK is subject to contractual obligations when working with payers directly such as timely filing limits and/or covered services. Although HOMELINK does get approval with the patient’s adjuster or case manager, payment is not guaranteed.

Service & Equipment Delivery/Pick-Up

By accepting referrals from HOMELINK, you acknowledge that your facility is responsible for instructing and training the patient or a caregiver on how to use the equipment/services that you provide.

Once delivery of equipment or services has been completed, please submit proof of delivery to HOMELINK via Fax: 877-786-6579 or E-mail: GetYourBillToUsFast@vgm.com

Pick-ups: Please notify HOMELINK immediately if you pick up equipment from the patient by calling 888-820-0355 or emailing us at HomelinkCallCenter@vgm.com.

Patient refusal of equipment/services: If a patient refuses the delivery of any equipment/services listed, please notify the Patient Care Coordinator (PCC) listed at the top of the of the HOMELINK Order Confirmation immediately.

Credentialing

By accepting this referral, you confirm that your staff and/or facility is compliant with all applicable Medicare requirements and accreditation standards.

HOMELINK contracts with a variety of payers that require us to credential any facility providing services to their patients. HOMELINK will provide you with separate electronic notice that a credentialing application must be completed and submitted within fifteen (15) business days of receipt of this confirmation. Failure of facility to submit a complete credentialing application and all supporting documents will result in a loss of referrals and/or payments being held.

To become credentialed with         HOMELINK, download, complete and send us the HOMELINK Provider Credentialing Packet for your service type: www.vgmhomelink.com/credentialing-information

Additional terms and protocols may apply to the following service types

• Transportation
• Physical Medicine

Transportation

Transportation Provider Expectations

1. When transporting a HOMELINK patient, multi-passenger runs are not acceptable unless approved by HOMELINK prior to the trip.

2. If there is an issue upon pick-up, the driver must notify HOMELINK within 5 minutes after the pick-up time and is not to be released without HOMELINK’s permission.

3. If at any point there is an issue during the transportation, HOMELINK must be notified of these issues immediately.

4. If wait time is authorized, HOMELINK should be contacted after two (2) hours of the driver waiting to receive direction on how to proceed. Do not release driver at the two-hour mark without HOMELINK approval.

5. The drivers should be professional and courteous to HOMELINK’s patients.

6. The drivers should never request payment/ time from the HOMELINK patient.

7. HOMELINK will pay $22.32 (unless negotiated prior to trip) if the driver arrives at the patient’s home and they do not get in the vehicle, or if the driver is on their way to pick the patient up and transportation is cancelled.

8. HOMELINK will call the provider business the night before the scheduled transportation as all transportation must be verbally verified. If verbal verification isn’t able to be received, an e-mail will suffice.

Other Terms and Conditions for Transportation Providers

• Wait time in excess of two (2) hours will require you or your driver to notify HOMELINK so additional authorization may be obtained.

• Any changes in type of service or loaded miles must be approved prior to patient pick-up.

• Loaded mileage is determined using a commercially available internet mapping program. The pricing information shown is what you may bill and what you will be paid. If you do not agree, please dispute prior to servicing client.

• If we do not receive a signed copy of the pricing structure, we will assume your silence is acceptance.

• Gratuity, taxes, and fuel charges are included in the rates noted above.

• Failure to transport patient to/from appointments, resulting in late fees, cancellation fees, doctor’s fees, or otherwise may be charged to or deducted from your account.

• Receipts must be provided for toll charges in order to be reimbursed.

If there are any concerns or questions, please contact our Transportation Department at 866-496-3580.

Physical Medicine

Physical Medicine Clinical Protocols

Participating Provider should have the ability to schedule a Covered Person within twenty-four to forty-eight hours from referral. All Covered Services will be coordinated with the Covered Person’s Payor through HOMELINK

Treatment visits should be scheduled appropriately and aggressively to promote early return to work. Home Exercise Programs should be developed at the initial visit and documentation of the patient’s compliance recorded as part of their progress notes. As a reminder the focus of the rehabilitation process must be functionally driven for a prompt return to work.

The Initial Referral from HOMELINK will be for the Initial Evaluation and the first day of therapeutic services. Based on clinical presentation including the physician’s script and co-morbidities, HOMELINK will provide promptly the authorization for additional visits. Participating Provider should fax or otherwise transmit to HOMELINK within 24 hours, a copy of the Initial Evaluation summary report outlining findings, proposed treatment, expected results and anticipated disability time frame

The clinic should track the number of visits authorized and prior to the completion of that number of authorized visits, should communicate to HOMELINK the anticipated number of visits that may be needed through clear, concise documentation of such need.

Participating Provider agrees to have the Covered Person fill out appropriate Care Connections questionnaires at the time of the initial visit and every fifth visit or two weeks, whichever is first. Participating Provider agrees to submit completed Care Connections questionnaires to HOMELINK upon completion of forms.

The first follow up visit should begin within 72 hours of the initial evaluation. All subsequent visits should be in a timely and consistent fashion to promote prompt recovery.

All progress notes will be required to be completed for each daily visit. Participating Provider will provide HOMELINK a copy of daily notes on a weekly basis. The progress note should include the following:

• Time in/out
• Time spent per each code billed
• Changes in the patient’s subjective presentation
• Changes in the patient’s objective presentation
• Daily assessment of the patient’s condition (e.g. improvement, decline, no change)
• Any changes in the treatment plan compared to previous documentation
• Update on outcomes score and pain scale should be done every two weeks or 5 visits (whichever comes first)
• Cancellations and no-show visits must be documented with the reason included

All therapy visits will be required to be documented and billed in reports and on claims submissions as to the specific minutes associated with treatment. The original bill for each Covered Person and the corresponding clinical documentation must be sent to HOMELINK.

Supervision of therapy will follow the applicable state practice guidelines.

All FCE’s should be confirmed the night before the appointment and documentation of cancellations or no shows should be communicated with HOMELINK, the physician and claims manager.

HOMELNK may request evaluation of job descriptions and completion of return to work restriction forms so that the Covered Person can be returned to productive activity. A re-evaluation charge for these testing and measurements will be authorized as a Covered Service if requested by HOMELINK or if the treating therapist identifies the intent of that service and receives pre-authorization from HOMELINK.

Participating Provider may be requested to provide status report on claimant(s) continuing to receive treatment outside evidence-based parameters. In such cases, HOMELINK will initiate such request by faxing to Participating Provider a questionnaire to be completed by the treating therapist who provides insight of claimant’s compliance and progress.   Status reports must be submitted to HOMELINK within 48 hours of report request.

Re-evaluations (97164, 97168) will be allowed only if a patient presents with the following:

• A patient returns from an extended period of absence from physical therapy (greater than one month)
• A patient presents with a significant change in condition
• HOMELINK requests an evaluation of job descriptions and completion of return to work restriction forms so the injured Covered Person can be returned to productive activity and the re-evaluation is pre-authorized

Consistently performing re-evaluations without the patient meeting the above criteria may trigger a review of documentation to determine if one of the above criteria supported the billing of a re-evaluation.

An Initial Evaluation will be allowed after a patient’s return from a surgical procedure.

Prior authorization is required before initiating work conditioning. A Work Conditioning Evaluation will be allowed (up to 10 units / 97750) on any patient not seen by a provider within your organization.

Prior to a patient scheduled for an FCE, HOMELINK will use best efforts to obtain the following:

• Documentation from previous course of care (prior therapist and/or physician)
• A job description
• Surgical and imaging reports if applicable.

If questions arise as to the patient’s clinical care, or in the case of FCE’s where additional job function information might be needed to adequately assess the patient, HOMELINK should be contacted.

The Participating Provider will follow a Cancellation / No Show policy. It is recommended that the provider attempt to re-schedule the patient within 2 days of the specific appointment scheduled and update  HOMELINK. If rescheduling continues, Participating Provider will advise claimant they may be reported as non-compliant and may be putting their TTD at risk by being so.

A discharge summary by fax or phone call should be sent to physician and the claims manager (case manager and/or adjustor) on record. All patient discharges should be reported to HOMELINK within 24 hours of discharge.