Use of PT Technician

[Guest guest]

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