So, why did CMS implement such a program?
410.26(b 1)-(7) and the CMS Medicare Benefit Policy Manual, Pub.
How Do I Enroll in Medicare?The supervising therapist has active ongoing involvement in the management and control of the patient's condition.Specifically, CMS explained that not all claims exceeding the therapy thresholds are subject to a manual medical review process as they were before.While Medicare doesnt require that patients visit their physician, some physicians may require an office visit prior to signing a POC.Gift-Giving According to compliance expert and WebPT guest author Tom Ambury, concerns about holiday gift-giving often revolve around the Anti-Kickback Statute (AKS)mostly because the AKS has a broad definition of who is considered a referral source.For information on how to bill within WebPT or with one of our integrated billers, click here.Treating without a Referral As a result of direct access, in most cases, Medicare patients may receive physical therapy services without seeing a physician or obtaining a referral first.Chapter 1 - Inpatient Hospital Services Covered Under Part A PDF, 488KB.
That means that a therapist may performand bill foran evaluation to determine whether therapy is medically necessary for that patient without involving a physician or other approved non-physician provider (NPP).
To stay in the clear on all gift-giving endeavors, Tom recommends following the below Office of Inspector General (OIG) Guidelines for Giftsand newest patch for dawn of war maintaining crystal clear documentation: No more than 10 per gift No more than 50 in aggregate over the course of a calendar year.The contractor stepping in for an on-vacation therapist who treats Medicare patients must also be Medicare-credentialed.To see the full list of codes, head to Table 24 on page 620 of the Final Rule.Cosign the daily note, but also have the PTA document that he or she provided services under the direct supervision of (name of the supervising therapist).In other words, rehab therapists cant accept cash payments from Medicare patients for medically necessary physical therapy services.Click here for greater detail on copayment collection for Medicare and third-party insurance beneficiaries.According to joint guidelines developed by the American Speech-Language-Hearing Association (asha American Occupational Therapy Association (aota and American Physical Therapy Association (apta for both Medicare Part A and B, therapists should only co-treat a patient when coordination between two disciplines benefits the patient.Chapter 8 Crosswalk PDF, 248KB, chapter 9 - Coverage of Hospice Services Under Hospital Insurance PDF, 618KB.Use of Non-Credentialed Therapists Contractors During the holiday season and summer vacation, private practices may need to hire substitutes, or contractors, to cover for their regularly employed therapists.