RE: Use of PT Technician

[Guest guest]

Hello ,

This is ine o, formerly Watts. I appreciate you reading the

Medicare Advisor but need to let you and the group know that the information

is as current as the day of publication and we do not update unless another

question is asked after regulations change. As you are aware, the

regulations change relatively frequently, especially in Skilled Nursing.

Anyhow, that being said, Medicare does not recognize the use of tech/aide,

in any site of service, as being able to provide skilled care. The time for

set up, under Part A SNF can be counted as included minutes if performed by

a tech/aide for the first mode that the area is being prepared for

treatment.

What other insurances allow is up to their individual definitions. The

other very important regulations to be aware of are the State Practice Acts,

which is probably the regulation under which the therapist should be

working. Just because an insurance may pay for aide time, the Practice Act

must be followed by the therapist.

I hope that information will be useful to you.

Regards,

ine

ine M. o, PT

Owner

Encompass Consulting & Education, LLC

8114 NW 100th Terrace, Tamarac, FL 33321-1259

We work hard to make sure you are " getting it right from the start " . Visit

our website at <http://www.encompassmedicare.com/>

www.encompassmedicare.com and see what we can do for you. While there sign

up for our free e-mail Newsletter " Medicare News and Rules for Therapists " .

We specialize in consulting services, seminars and customized education

services to providers of Medicare rehabilitation therapy and related

services.

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From: PTManager [mailto:PTManager ] On Behalf

Of mlavcavitt@...

Sent: Sunday, September 25, 2011 9:06 AM

To: PTManager

Subject: Use of PT Technician

Dear List,

I recently ran across an article in Advance for Physical Therapy & Rehab

Medicine entitled " Medicare Advisor: Rehab Techs and Rehab Low Billing for

Rehab Tech Services. " The article was written by ine Watts, MCSP, PT

and Danna D. Mullins, MHS, PT.

The following question was posed, " Will Medicare pay when rehab techs

handle patients? If not, what will happen if surveyors find out we do this?

Finally, what can I read with regard to how to properly document care to

reduce denials? "

The answer, " The worst thing that can happen to you personally is that you

could be prosecuted for Medicare fraud, be fined or imprisoned, and lose

your license to practice physical therapy. medicare regulations

emphatically state that it will not pay for services that do not require the

skills of

a therapist. If you physical therapy technicians are doing the ambulation

and exercises, it is not considered a skilled services. If services

provided by techs are being billed to Medicare as skilled gait training and

therapeutic exercises then the facility is committing Medicare fraud. Even

if

services performed by a technician are under the direct line-of-sight

supervision of a physical therapist, they are not recognized as skilled and,

are

not billable under Medicare guidelines.

Regarding therapy technicians and supervision, see the Federal Register

July 30, 1999 (64 (146) pp. 41643-41683. Medicare program; prospective

payment system and consolidated billing for skilled nursing

facilities-update;

final rule and notice, Section J. Rehabilitation Therapy Services and PPS).

As to what constitutes skilled therapy for coverage of service, refer to

HCFA's Skilled Nursing Manual, 214.3 and 271.

With regard to documentation to reduce denials, refer to Medicare's Program

Integrity Manual, Chapter 6. "

My question is does anyone have any knowledge if this same rule applies for

BCBS of Louisiana. I can't find any ruling on this on the BCBSLA website

and get several different answers when I have contacted BCBSLA directly.

I would like to see something in writing before I advise my clients.

Thanks in advance for your assistance.

D. Cavitt, President

Rehab Billing Specialists, L.L.C.

600 Guilbeau Road, Suite A

Lafayette, LA 70506