Guest guest Posted January 6, 2011 Report Share Posted January 6, 2011 I was wondering if the managers in Florida could comment on this. I only pick on Florida because it does not seem to be an issue with other out of state patients. We have many patients that " winter over " in Florida. These are Medicare age patients. For example patient has surgery in Wisconsin is doing rehab here but then goes to Florida for the rest of the winter. We have been told by many current physical therapy patients that if they need to continue with physical therapy in Florida they must go to a Florida MD and then obtain a script to physical therapy. This seems like an unneeded visit to an MD who has never seen this individual and knows nothing about what surgery this individual has had other than what the patient tells them. Is this required Florida MD exam idea correct? Is this a Florida law or the MC intermediary law or individual facility policy or just a bunch of bonk? Carl Grota, PT Ministry Door County Medical Center Rehab Services 1300 Egg Harbor Rd Ste #108 Sturgeon Bay Wi 54235 ph: Fax: ________________________________ ________________________________ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 6, 2011 Report Share Posted January 6, 2011 I don't believe it is an issue with the payers, Medicare included. I only know that in our state ( KY) a script from an MD not licensed in KY is considered as the individual practicing without a license and therefore unacceptable. I believe the only thing that is acceptable is a lab or xray order since it is not technically rendering " care " Ron Barbato PT rbarbato@... PRIVILEGED AND CONFIDENTIAL: This transmission may contain information that is privileged subject to attorney-client privilege or attorney work product, confidential and/or exempt from disclosure under applicable law. If you are not the intended recipient, then please do not read it and be aware that any disclosure, copying, distribution, or use of the information contained herein (including any reliance thereon) is STRICTLY PROHIBITED. If you received this transmission in error, please immediately advise me, by reply e-mail, and delete this message and any attachments without retaining a copy in any form. Thank you. RE: Florida PT script I was wondering if the managers in Florida could comment on this. I only pick on Florida because it does not seem to be an issue with other out of state patients. We have many patients that " winter over " in Florida. These are Medicare age patients. For example patient has surgery in Wisconsin is doing rehab here but then goes to Florida for the rest of the winter. We have been told by many current physical therapy patients that if they need to continue with physical therapy in Florida they must go to a Florida MD and then obtain a script to physical therapy. This seems like an unneeded visit to an MD who has never seen this individual and knows nothing about what surgery this individual has had other than what the patient tells them. Is this required Florida MD exam idea correct? Is this a Florida law or the MC intermediary law or individual facility policy or just a bunch of bonk? Carl Grota, PT Ministry Door County Medical Center Rehab Services 1300 Egg Harbor Rd Ste #108 Sturgeon Bay Wi 54235 ph: Fax: ________________________________ ________________________________ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 6, 2011 Report Share Posted January 6, 2011 Carl: I am a PT in Florida. I go by the rule that we, as an autonomous practice state, can see a patient for 3 weeks without a referral. After that they need to be seen by a physician. Most of our " snow birds " have temporary physicians down here, as they, for one reason or another, often see a physician for something, even if its a drug refill that an out of state physician can't write. I'd be interested to hear if you got any responses from any other Florida PT's. Thanks, Seidner, PT, DC Subject: RE: Florida PT script To: " PTManager " <PTManager > Date: Thursday, January 6, 2011, 1:49 PM Â I was wondering if the managers in Florida could comment on this. I only pick on Florida because it does not seem to be an issue with other out of state patients. We have many patients that " winter over " in Florida. These are Medicare age patients. For example patient has surgery in Wisconsin is doing rehab here but then goes to Florida for the rest of the winter. We have been told by many current physical therapy patients that if they need to continue with physical therapy in Florida they must go to a Florida MD and then obtain a script to physical therapy. This seems like an unneeded visit to an MD who has never seen this individual and knows nothing about what surgery this individual has had other than what the patient tells them. Is this required Florida MD exam idea correct? Is this a Florida law or the MC intermediary law or individual facility policy or just a bunch of bonk? Carl Grota, PT Ministry Door County Medical Center Rehab Services 1300 Egg Harbor Rd Ste #108 Sturgeon Bay Wi 54235 ph: Fax: ________________________________ ________________________________ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 6, 2011 Report Share Posted January 6, 2011 If you will look on the FPTA website you will get the answer to your question. There was a statement about a year or so ago dealing with this issue. I believe it is still on the website under the topic of Direct Access. Understand however that Medicare patients currently can not be seen under direct access. Engelberg, PT Manager, Outpatient Rehabilitation Orlando Health 321 841-6581 stephanie.engelberg@... Visit us on the web at http://www.orlandohealth.com/rehab<http://www.orlandohelath.com/rehab> From: PTManager [mailto:PTManager ] On Behalf Of Grota, Carl D Sent: Thursday, January 06, 2011 1:49 PM To: PTManager Subject: RE: Florida PT script I was wondering if the managers in Florida could comment on this. I only pick on Florida because it does not seem to be an issue with other out of state patients. We have many patients that " winter over " in Florida. These are Medicare age patients. For example patient has surgery in Wisconsin is doing rehab here but then goes to Florida for the rest of the winter. We have been told by many current physical therapy patients that if they need to continue with physical therapy in Florida they must go to a Florida MD and then obtain a script to physical therapy. This seems like an unneeded visit to an MD who has never seen this individual and knows nothing about what surgery this individual has had other than what the patient tells them. Is this required Florida MD exam idea correct? Is this a Florida law or the MC intermediary law or individual facility policy or just a bunch of bonk? Carl Grota, PT Ministry Door County Medical Center Rehab Services 1300 Egg Harbor Rd Ste #108 Sturgeon Bay Wi 54235 ph: Fax: ________________________________ ________________________________ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 6, 2011 Report Share Posted January 6, 2011 Hi Carl. In the state of FL we can treat without a prescription for 21 days which basically is what they consider an out of state physician. If the patients require more than 3 weeks of therapy, we send them to a local walk-in clinic with a letter explaining the situation. I probably have a dozen patients in this situation right now and a most from MI . I have always wondered if you have billboards advertising Panama City Beach for the winter! Hodges, MPT Clinic Manager Sacred Heart Rehabilitation Center at Panama City Beach fax ________________________________ From: PTManager [mailto:PTManager ] On Behalf Of Grota, Carl D Sent: Thursday, January 06, 2011 12:49 PM To: PTManager Subject: RE: Florida PT script I was wondering if the managers in Florida could comment on this. I only pick on Florida because it does not seem to be an issue with other out of state patients. We have many patients that " winter over " in Florida. These are Medicare age patients. For example patient has surgery in Wisconsin is doing rehab here but then goes to Florida for the rest of the winter. We have been told by many current physical therapy patients that if they need to continue with physical therapy in Florida they must go to a Florida MD and then obtain a script to physical therapy. This seems like an unneeded visit to an MD who has never seen this individual and knows nothing about what surgery this individual has had other than what the patient tells them. Is this required Florida MD exam idea correct? Is this a Florida law or the MC intermediary law or individual facility policy or just a bunch of bonk? Carl Grota, PT Ministry Door County Medical Center Rehab Services 1300 Egg Harbor Rd Ste #108 Sturgeon Bay Wi 54235 ph: Fax: ________________________________ ________________________________ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 6, 2011 Report Share Posted January 6, 2011 Outside of autonomous practice... It is important for those therapists that work in hospitals (Licensed/JCAHO ect) to look at the organizations bylaws. Can you accept referrals from MD's/DO's that are not licensed in your state? If so , does your state medical practice act allow for out of state MD's /DO's not licensed in the state to practice medicine( referral for treatment is practicing medicine) Ron Barbato PT Administrative Director, Rehabilitation Services Program Director, Cancer Support Services Ephraim McDowell Health rbarbato@... PRIVILEGED AND CONFIDENTIAL: This transmission may contain information that is privileged subject to attorney-client privilege or attorney work product, confidential and/or exempt from disclosure under applicable law. If you are not the intended recipient, then please do not read it and be aware that any disclosure, copying, distribution, or use of the information contained herein (including any reliance thereon) is STRICTLY PROHIBITED. If you received this transmission in error, please immediately advise me, by reply e-mail, and delete this message and any attachments without retaining a copy in any form. Thank you. RE: Florida PT script I was wondering if the managers in Florida could comment on this. I only pick on Florida because it does not seem to be an issue with other out of state patients. We have many patients that " winter over " in Florida. These are Medicare age patients. For example patient has surgery in Wisconsin is doing rehab here but then goes to Florida for the rest of the winter. We have been told by many current physical therapy patients that if they need to continue with physical therapy in Florida they must go to a Florida MD and then obtain a script to physical therapy. This seems like an unneeded visit to an MD who has never seen this individual and knows nothing about what surgery this individual has had other than what the patient tells them. Is this required Florida MD exam idea correct? Is this a Florida law or the MC intermediary law or individual facility policy or just a bunch of bonk? Carl Grota, PT Ministry Door County Medical Center Rehab Services 1300 Egg Harbor Rd Ste #108 Sturgeon Bay Wi 54235 ph: Fax: ________________________________ ________________________________ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 6, 2011 Report Share Posted January 6, 2011 Carl, We do the same as suggests, 3 weeks then to any f/u MD for script. We get lots of snow birds this time of year. Mark Niles PT, MS, CSCS Orthopedic Specialists PA mniles@... x3 fax This message, together with any attachments, is intended only for the addressee. It may contain information which is legally privileged, confidential and exempt from disclosure. If you are not the intended recipient, you are hereby notified that any disclosure, copying, distribution, use, or any action or reliance on this communication is strictly prohibited. If you have received this e-mail in error, please notify the sender immediately by telephone ( x3) or by return e-mail and delete the message, along with any attachments From: PTManager [mailto:PTManager ] On Behalf Of david seidner Sent: Thursday, January 06, 2011 2:25 PM To: PTManager Subject: RE: Florida PT script Carl: I am a PT in Florida. I go by the rule that we, as an autonomous practice state, can see a patient for 3 weeks without a referral. After that they need to be seen by a physician. Most of our " snow birds " have temporary physicians down here, as they, for one reason or another, often see a physician for something, even if its a drug refill that an out of state physician can't write. I'd be interested to hear if you got any responses from any other Florida PT's. Thanks, Seidner, PT, DC From: Grota, Carl D <carl.grota@... <mailto:carl.grota%40ministryhealth.org> > Subject: RE: Florida PT script To: " PTManager <mailto:PTManager%40yahoogroups.com> " <PTManager <mailto:PTManager%40yahoogroups.com> > Date: Thursday, January 6, 2011, 1:49 PM I was wondering if the managers in Florida could comment on this. I only pick on Florida because it does not seem to be an issue with other out of state patients. We have many patients that " winter over " in Florida. These are Medicare age patients. For example patient has surgery in Wisconsin is doing rehab here but then goes to Florida for the rest of the winter. We have been told by many current physical therapy patients that if they need to continue with physical therapy in Florida they must go to a Florida MD and then obtain a script to physical therapy. This seems like an unneeded visit to an MD who has never seen this individual and knows nothing about what surgery this individual has had other than what the patient tells them. Is this required Florida MD exam idea correct? Is this a Florida law or the MC intermediary law or individual facility policy or just a bunch of bonk? Carl Grota, PT Ministry Door County Medical Center Rehab Services 1300 Egg Harbor Rd Ste #108 Sturgeon Bay Wi 54235 ph: Fax: ________________________________ ________________________________ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 6, 2011 Report Share Posted January 6, 2011 , What did you mean by " Understand however that Medicare patients currently cannot be seen under direct access. " You mean during the initial 21 days in FL? Mark Niles PT, MS, CSCS Orthopedic Specialists PA mniles@... x3 fax This message, together with any attachments, is intended only for the addressee. It may contain information which is legally privileged, confidential and exempt from disclosure. If you are not the intended recipient, you are hereby notified that any disclosure, copying, distribution, use, or any action or reliance on this communication is strictly prohibited. If you have received this e-mail in error, please notify the sender immediately by telephone ( x3) or by return e-mail and delete the message, along with any attachments From: PTManager [mailto:PTManager ] On Behalf Of Engelberg, Sent: Thursday, January 06, 2011 2:43 PM To: PTManager Subject: RE: Florida PT script If you will look on the FPTA website you will get the answer to your question. There was a statement about a year or so ago dealing with this issue. I believe it is still on the website under the topic of Direct Access. Understand however that Medicare patients currently can not be seen under direct access. Engelberg, PT Manager, Outpatient Rehabilitation Orlando Health 321 841-6581 stephanie.engelberg@... <mailto:stephanie.engelberg%40orlandohealth.com> Visit us on the web at http://www.orlandohealth.com/rehab<http://www.orlandohelath.com/rehab> From: PTManager <mailto:PTManager%40yahoogroups.com> [mailto:PTManager <mailto:PTManager%40yahoogroups.com> ] On Behalf Of Grota, Carl D Sent: Thursday, January 06, 2011 1:49 PM To: PTManager <mailto:PTManager%40yahoogroups.com> Subject: RE: Florida PT script I was wondering if the managers in Florida could comment on this. I only pick on Florida because it does not seem to be an issue with other out of state patients. We have many patients that " winter over " in Florida. These are Medicare age patients. For example patient has surgery in Wisconsin is doing rehab here but then goes to Florida for the rest of the winter. We have been told by many current physical therapy patients that if they need to continue with physical therapy in Florida they must go to a Florida MD and then obtain a script to physical therapy. This seems like an unneeded visit to an MD who has never seen this individual and knows nothing about what surgery this individual has had other than what the patient tells them. Is this required Florida MD exam idea correct? Is this a Florida law or the MC intermediary law or individual facility policy or just a bunch of bonk? Carl Grota, PT Ministry Door County Medical Center Rehab Services 1300 Egg Harbor Rd Ste #108 Sturgeon Bay Wi 54235 ph: Fax: ________________________________ ________________________________ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 6, 2011 Report Share Posted January 6, 2011 Whoa folks, There has to be some important clarification here. If we are talking about outpatient PT: First of all, no Part B (outpatient) Medicare patient in any state can be seen under Direct Access laws so throw out that as an option. Second, Medicare does not require a prescription to treat. It does require physician certification and an approved treatment plan. A signed treatment plan from a physician in another state would be the issue, however, there is nothing in the Medicare Policy Benefits manual that I have found to specifically answer your question. Remember, however, that a Part B initial certification is good for 90 days so if they come to your clinic already certified by a physician, then they are approved, by Medicare rules to be treated under the approved treatment plan. If you need to change the plan at any point within the first 90 days, then you would have to get physician approval. The clause that may cause problems is that in order to qualify your treatment as reasonable and necessary, the Medicare beneficiary must be under the care of a physician. It could be argued that unless they have a local physician they are under the care of (and for the problem that you are treating), then they are out of compliance. As much as it seems a waste of time and money, I believe that having a local physician involved makes sense especially if you need to change the plan or if you see the person beyond the initial 90 days and need to recertify. Plus what about medication issues, complex medical problems that may need to be addressed etc. Makes sense that they are hooked up with a local physician anyway. These are the rules we have and until we can get the physician lobby to back down and get Congress to change the Medicare rules to allow Direct Access, we have to follow the rules we have. Tom Howell, P.T., M.P.T. Howell Physical Therapy Eagle, ID thowell@... This email and any files transmitted with it may contain PRIVILEGED or CONFIDENTIAL information and may be read or used only by the intended recipient. If you are not the intended recipient of the email or any of its attachments, please be advised that you have received this email in error and that any use, dissemination, distribution, forwarding, printing or copying of this email or any attached files is strictly prohibited. If you have received this email in error, please immediately purge it and all attachments and notify the sender by reply email. _____ From: PTManager [mailto:PTManager ] On Behalf Of Grota, Carl D Sent: Thursday, January 06, 2011 11:49 AM To: PTManager Subject: RE: Florida PT script I was wondering if the managers in Florida could comment on this. I only pick on Florida because it does not seem to be an issue with other out of state patients. We have many patients that " winter over " in Florida. These are Medicare age patients. For example patient has surgery in Wisconsin is doing rehab here but then goes to Florida for the rest of the winter. We have been told by many current physical therapy patients that if they need to continue with physical therapy in Florida they must go to a Florida MD and then obtain a script to physical therapy. This seems like an unneeded visit to an MD who has never seen this individual and knows nothing about what surgery this individual has had other than what the patient tells them. Is this required Florida MD exam idea correct? Is this a Florida law or the MC intermediary law or individual facility policy or just a bunch of bonk? Carl Grota, PT Ministry Door County Medical Center Rehab Services 1300 Egg Harbor Rd Ste #108 Sturgeon Bay Wi 54235 ph: Fax: ________________________________ ________________________________ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 6, 2011 Report Share Posted January 6, 2011 What I meant was that medicare requires a physician of record to sign the poc. Hence you can see the patient without the referral do your eval and then submit the poc to the physician of record. In Fl the state practice act states that a referral (after the 21 days of direct access) must come from a Fl licensed physician (the grey area is if a physician of record has to be licensed in the state). Hope this makes sense. Engelberg From: Mark Niles Sent: Thursday, January 06, 2011 03:14 PM To: PTManager <PTManager > Subject: RE: Florida PT script , What did you mean by " Understand however that Medicare patients currently cannot be seen under direct access. " You mean during the initial 21 days in FL? Mark Niles PT, MS, CSCS Orthopedic Specialists PA mniles@...<mailto:mniles%40orthospecpa.net> x3 fax This message, together with any attachments, is intended only for the addressee. It may contain information which is legally privileged, confidential and exempt from disclosure. If you are not the intended recipient, you are hereby notified that any disclosure, copying, distribution, use, or any action or reliance on this communication is strictly prohibited. If you have received this e-mail in error, please notify the sender immediately by telephone ( x3) or by return e-mail and delete the message, along with any attachments From: PTManager <mailto:PTManager%40yahoogroups.com> [mailto:PTManager <mailto:PTManager%40yahoogroups.com>] On Behalf Of Engelberg, Sent: Thursday, January 06, 2011 2:43 PM To: PTManager <mailto:PTManager%40yahoogroups.com> Subject: RE: Florida PT script If you will look on the FPTA website you will get the answer to your question. There was a statement about a year or so ago dealing with this issue. I believe it is still on the website under the topic of Direct Access. Understand however that Medicare patients currently can not be seen under direct access. Engelberg, PT Manager, Outpatient Rehabilitation Orlando Health 321 841-6581 stephanie.engelberg@...<mailto:stephanie.engelberg%40orlandohealth\ ..com> <mailto:stephanie.engelberg%40orlandohealth.com> Visit us on the web at http://www.orlandohealth.com/rehab<http://www.orlandohelath.com/rehab> From: PTManager <mailto:PTManager%40yahoogroups.com> <mailto:PTManager%40yahoogroups.com> [mailto:PTManager <mailto:PTManager%40yahoogroups.com> <mailto:PTManager%40yahoogroups.com> ] On Behalf Of Grota, Carl D Sent: Thursday, January 06, 2011 1:49 PM To: PTManager <mailto:PTManager%40yahoogroups.com> <mailto:PTManager%40yahoogroups.com> Subject: RE: Florida PT script I was wondering if the managers in Florida could comment on this. I only pick on Florida because it does not seem to be an issue with other out of state patients. We have many patients that " winter over " in Florida. These are Medicare age patients. For example patient has surgery in Wisconsin is doing rehab here but then goes to Florida for the rest of the winter. We have been told by many current physical therapy patients that if they need to continue with physical therapy in Florida they must go to a Florida MD and then obtain a script to physical therapy. This seems like an unneeded visit to an MD who has never seen this individual and knows nothing about what surgery this individual has had other than what the patient tells them. Is this required Florida MD exam idea correct? Is this a Florida law or the MC intermediary law or individual facility policy or just a bunch of bonk? Carl Grota, PT Ministry Door County Medical Center Rehab Services 1300 Egg Harbor Rd Ste #108 Sturgeon Bay Wi 54235 ph: Fax: ________________________________ ________________________________ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 7, 2011 Report Share Posted January 7, 2011 Providing PT in FL to a MC patient with an out of state physician signing the POC is not a problem at all provided the physician has an NPI. This is per the FL intermediary. Witt PT Segal & Witt Physical Therapy Delray Beach, FL On Jan 6, 2011, at 4:27 PM, " M. Howell, PT, MPT " wrote: > Whoa folks, > > There has to be some important clarification here. > > If we are talking about outpatient PT: > > First of all, no Part B (outpatient) Medicare patient in any state can be > seen under Direct Access laws so throw out that as an option. > > Second, Medicare does not require a prescription to treat. It does require > physician certification and an approved treatment plan. > > A signed treatment plan from a physician in another state would be the > issue, however, there is nothing in the Medicare Policy Benefits manual that > I have found to specifically answer your question. Remember, however, that > a Part B initial certification is good for 90 days so if they come to your > clinic already certified by a physician, then they are approved, by Medicare > rules to be treated under the approved treatment plan. If you need to > change the plan at any point within the first 90 days, then you would have > to get physician approval. > > The clause that may cause problems is that in order to qualify your > treatment as reasonable and necessary, the Medicare beneficiary must be > under the care of a physician. It could be argued that unless they have a > local physician they are under the care of (and for the problem that you are > treating), then they are out of compliance. > > As much as it seems a waste of time and money, I believe that having a local > physician involved makes sense especially if you need to change the plan or > if you see the person beyond the initial 90 days and need to recertify. > Plus what about medication issues, complex medical problems that may need to > be addressed etc. Makes sense that they are hooked up with a local > physician anyway. > > These are the rules we have and until we can get the physician lobby to back > down and get Congress to change the Medicare rules to allow Direct Access, > we have to follow the rules we have. > > Tom Howell, P.T., M.P.T. > > Howell Physical Therapy > > Eagle, ID > > thowell@... > > This email and any files transmitted with it may contain PRIVILEGED or > CONFIDENTIAL information and may be read or used only by the intended > recipient. If you are not the intended recipient of the email or any of its > attachments, please be advised that you have received this email in error > and that any use, dissemination, distribution, forwarding, printing or > copying of this email or any attached files is strictly prohibited. If you > have received this email in error, please immediately purge it and all > attachments and notify the sender by reply email. > > _____ > > From: PTManager [mailto:PTManager ] On Behalf > Of Grota, Carl D > Sent: Thursday, January 06, 2011 11:49 AM > To: PTManager > Subject: RE: Florida PT script > > I was wondering if the managers in Florida could comment on this. I only > pick on Florida because it does not seem to be an issue with other out of > state patients. > We have many patients that " winter over " in Florida. These are Medicare age > patients. For example patient has surgery in Wisconsin is doing rehab here > but then goes to Florida for the rest of the winter. We have been told by > many current physical therapy patients that if they need to continue with > physical therapy in Florida they must go to a Florida MD and then obtain a > script to physical therapy. This seems like an unneeded visit to an MD who > has never seen this individual and knows nothing about what surgery this > individual has had other than what the patient tells them. Is this required > Florida MD exam idea correct? Is this a Florida law or the MC intermediary > law or individual facility policy or just a bunch of bonk? > > Carl Grota, PT > Ministry Door County Medical Center > Rehab Services > 1300 Egg Harbor Rd Ste #108 > Sturgeon Bay Wi 54235 > ph: > Fax: > ________________________________ > > ________________________________ > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 7, 2011 Report Share Posted January 7, 2011 Here's the exerpt from the Florida PT Practice act that relates to the question: " A physical therapist may implement a plan of treatment for a patient. The physical therapist shall refer the patient to or consult with a health care practitioner licensed under chapter 458, chapter 459, chapter 460, chapter 461, or chapter 466, if the patient's condition is found to be outside the scope of physical therapy. If physical therapy treatment for a patient is required beyond 21 days for a condition not previously assessed by a practitioner of record, the physical therapist shall obtain a practitioner of record who will review and sign the plan. A health care practitioner licensed under chapter 458, chapter 459, chapter 460, chapter 461, or chapter 466 and engaged in active practice is eligible to serve as a practitioner of record. " " chapter " refers to Florida laws providing for licensure of: 458 = MD, 459 = DO (osteopath), 460 = DC (chiro), 460 = DPM (podiatrist), 466 = DDS (Dentis) So, bottom line: Florida PT practice act only recognizes Florida licenced MDs, DOs, DCs, DPMs, and DDSs as " practitioners of record. " Adele (Del) Carr, PT Assist. Prof. State College of Florida PTA Program carra@... > > Whoa folks, > > There has to be some important clarification here. > > > > If we are talking about outpatient PT: > > First of all, no Part B (outpatient) Medicare patient in any state can be > seen under Direct Access laws so throw out that as an option. > > > > Second, Medicare does not require a prescription to treat. It does require > physician certification and an approved treatment plan. > > A signed treatment plan from a physician in another state would be the > issue, however, there is nothing in the Medicare Policy Benefits manual that > I have found to specifically answer your question. Remember, however, that > a Part B initial certification is good for 90 days so if they come to your > clinic already certified by a physician, then they are approved, by Medicare > rules to be treated under the approved treatment plan. If you need to > change the plan at any point within the first 90 days, then you would have > to get physician approval. > > > > The clause that may cause problems is that in order to qualify your > treatment as reasonable and necessary, the Medicare beneficiary must be > under the care of a physician. It could be argued that unless they have a > local physician they are under the care of (and for the problem that you are > treating), then they are out of compliance. > > As much as it seems a waste of time and money, I believe that having a local > physician involved makes sense especially if you need to change the plan or > if you see the person beyond the initial 90 days and need to recertify. > Plus what about medication issues, complex medical problems that may need to > be addressed etc. Makes sense that they are hooked up with a local > physician anyway. > > > > These are the rules we have and until we can get the physician lobby to back > down and get Congress to change the Medicare rules to allow Direct Access, > we have to follow the rules we have. > > > > Tom Howell, P.T., M.P.T. > > Howell Physical Therapy > > Eagle, ID > > thowell@... > > > > > > This email and any files transmitted with it may contain PRIVILEGED or > CONFIDENTIAL information and may be read or used only by the intended > recipient. If you are not the intended recipient of the email or any of its > attachments, please be advised that you have received this email in error > and that any use, dissemination, distribution, forwarding, printing or > copying of this email or any attached files is strictly prohibited. If you > have received this email in error, please immediately purge it and all > attachments and notify the sender by reply email. > > > > > > _____ > > From: PTManager [mailto:PTManager ] On Behalf > Of Grota, Carl D > Sent: Thursday, January 06, 2011 11:49 AM > To: PTManager > Subject: RE: Florida PT script > > > > > > I was wondering if the managers in Florida could comment on this. I only > pick on Florida because it does not seem to be an issue with other out of > state patients. > We have many patients that " winter over " in Florida. These are Medicare age > patients. For example patient has surgery in Wisconsin is doing rehab here > but then goes to Florida for the rest of the winter. We have been told by > many current physical therapy patients that if they need to continue with > physical therapy in Florida they must go to a Florida MD and then obtain a > script to physical therapy. This seems like an unneeded visit to an MD who > has never seen this individual and knows nothing about what surgery this > individual has had other than what the patient tells them. Is this required > Florida MD exam idea correct? Is this a Florida law or the MC intermediary > law or individual facility policy or just a bunch of bonk? > > Carl Grota, PT > Ministry Door County Medical Center > Rehab Services > 1300 Egg Harbor Rd Ste #108 > Sturgeon Bay Wi 54235 > ph: > Fax: > ________________________________ > > ________________________________ > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 7, 2011 Report Share Posted January 7, 2011 Group: The issue has to do with following the Practice Act in the State of Florida, not Medicare. Because Florida does have Direct Access, there is a statement indicating the need for a " Florida licensed Physician " to sign the treatment plan after 21 consecutive calendar days. Physicians licensed in other states do no meet this requirement. Howell is correct in the Medicare portion of his statement, but you can't throw out the practice act of the state the patient is receiving care. I hope this helps provide clarity! Stuart J. Meaux, P. T., MSHA Director of Physical Rehabilitation Services Sacred Heart Hospital on the Emerald Coast Miramar Beach, Florida (w) © (p) ________________________________ From: PTManager [mailto:PTManager ] On Behalf Of M. Howell, PT, MPT Sent: Thursday, January 06, 2011 3:28 PM To: PTManager Subject: RE: Florida PT script Whoa folks, There has to be some important clarification here. If we are talking about outpatient PT: First of all, no Part B (outpatient) Medicare patient in any state can be seen under Direct Access laws so throw out that as an option. Second, Medicare does not require a prescription to treat. It does require physician certification and an approved treatment plan. A signed treatment plan from a physician in another state would be the issue, however, there is nothing in the Medicare Policy Benefits manual that I have found to specifically answer your question. Remember, however, that a Part B initial certification is good for 90 days so if they come to your clinic already certified by a physician, then they are approved, by Medicare rules to be treated under the approved treatment plan. If you need to change the plan at any point within the first 90 days, then you would have to get physician approval. The clause that may cause problems is that in order to qualify your treatment as reasonable and necessary, the Medicare beneficiary must be under the care of a physician. It could be argued that unless they have a local physician they are under the care of (and for the problem that you are treating), then they are out of compliance. As much as it seems a waste of time and money, I believe that having a local physician involved makes sense especially if you need to change the plan or if you see the person beyond the initial 90 days and need to recertify. Plus what about medication issues, complex medical problems that may need to be addressed etc. Makes sense that they are hooked up with a local physician anyway. These are the rules we have and until we can get the physician lobby to back down and get Congress to change the Medicare rules to allow Direct Access, we have to follow the rules we have. Tom Howell, P.T., M.P.T. Howell Physical Therapy Eagle, ID thowell@...<mailto:thowell%40fiberpipe.net> This email and any files transmitted with it may contain PRIVILEGED or CONFIDENTIAL information and may be read or used only by the intended recipient. If you are not the intended recipient of the email or any of its attachments, please be advised that you have received this email in error and that any use, dissemination, distribution, forwarding, printing or copying of this email or any attached files is strictly prohibited. If you have received this email in error, please immediately purge it and all attachments and notify the sender by reply email. _____ From: PTManager <mailto:PTManager%40yahoogroups.com> [mailto:PTManager <mailto:PTManager%40yahoogroups.com>] On Behalf Of Grota, Carl D Sent: Thursday, January 06, 2011 11:49 AM To: PTManager <mailto:PTManager%40yahoogroups.com> Subject: RE: Florida PT script I was wondering if the managers in Florida could comment on this. I only pick on Florida because it does not seem to be an issue with other out of state patients. We have many patients that " winter over " in Florida. These are Medicare age patients. For example patient has surgery in Wisconsin is doing rehab here but then goes to Florida for the rest of the winter. We have been told by many current physical therapy patients that if they need to continue with physical therapy in Florida they must go to a Florida MD and then obtain a script to physical therapy. This seems like an unneeded visit to an MD who has never seen this individual and knows nothing about what surgery this individual has had other than what the patient tells them. Is this required Florida MD exam idea correct? Is this a Florida law or the MC intermediary law or individual facility policy or just a bunch of bonk? Carl Grota, PT Ministry Door County Medical Center Rehab Services 1300 Egg Harbor Rd Ste #108 Sturgeon Bay Wi 54235 ph: Fax: ________________________________ ________________________________ Quote Link to comment Share on other sites More sharing options...
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