Medicare part B and PT students

[Guest guest]

List serve,

Please refresh my memory concerning the ability of PT students to see medicare

part B patients in the outpatient setting. I thought the student could work

with the medicare patient as long as the PT was within " line of sight " and did

not have other patients billed at that same time. I realize that the ruling has

changed over the years. thank you and Happy New Year.

Matt Dvorak, PT

Yankton, SD

[Guest guest]

The therapist or assistant must be directing and participating in the treatment

session with the patient and student and doing nothing else. Here is the

reference. Read Section 230 A & B.

http://www.cms.gov/manuals/Downloads/bp102c15.pdf

Here is the exact language:

B. Therapy Students

1. General

Only the services of the therapist can be billed and paid under Medicare Part B.

The services performed by a student are not reimbursed even if provided under

“line of sight†supervision of the therapist; however, the presence of the

student “in the room†does not make the service unbillable. Pay for the

direct (one-to-one) patient contact services of the physician or therapist

provided to Medicare Part B patients. Group therapy services performed by a

therapist or physician may be billed when a student is also present “in the

roomâ€.

EXAMPLES:

Therapists may bill and be paid for the provision of services in the following

scenarios:

•    The qualified practitioner is present and in the room for the entire

session. The student participates in the delivery of services when the qualified

practitioner is directing the service, making the skilled judgment, and is

responsible for the assessment and treatment.

•    The qualified practitioner is present in the room guiding the student

in service delivery when the therapy student and the therapy assistant student

are participating in the provision of services, and the practitioner is not

engaged in treating another patient or doing other tasks at the same time.

•    The qualified practitioner is responsible for the services and as

such, signs all documentation. (A student may, of course, also sign but it is

not necessary since the Part B payment is for the clinician’s service, not for

the student’s services).

2. Therapy Assistants as Clinical Instructors

Physical therapist assistants and occupational therapy assistants are not

precluded from serving as clinical instructors for therapy students, while

providing services within their scope of work and performed under the direction

and supervision of a licensed physical or occupational therapist to a Medicare

beneficiary.

3. Services Provided Under Part A and Part B

The payment methodologies for Part A and B therapy services rendered by a

student are different. Under the MPFS (Medicare Part , Medicare pays for

services provided by physicians and practitioners that are specifically

authorized by statute. Students do not meet the definition of practitioners

under Medicare Part B. Under SNF PPS, payments are based upon the case mix or

Resource Utilization Group (RUG) category that describes the patient. In the

rehabilitation groups, the number of therapy minutes delivered to the patient

determines the RUG category. Payment levels for each category are based upon the

costs of caring for patients in each group rather than providing specific

payment for each therapy service as is done in Medicare Part B.

Rick Gawenda, PT

President

Gawenda Seminars & Consulting, Inc.

www.gawendaseminars.com

Follow Gawenda Seminars & Consulting, Inc on Facebook

Register for January 24, 2012 audio conference " 2012 Medicare & Private Payor

Updates " at

https://www.showmyevent.com/events/viewEventDetails.aspx?EventID=1735

Subject: Medicare part B and PT students

To: PTmanager

Date: Friday, January 6, 2012, 12:19 PM

 

List serve,

Please refresh my memory concerning the ability of PT students to see medicare

part B patients in the outpatient setting. I thought the student could work

with the medicare patient as long as the PT was within " line of sight " and did

not have other patients billed at that same time. I realize that the ruling has

changed over the years. thank you and Happy New Year.

Matt Dvorak, PT

Yankton, SD

[Guest guest]

The therapist or assistant must be directing and participating in the treatment

session with the patient and student and doing nothing else. Here is the

reference. Read Section 230 A & B.

http://www.cms.gov/manuals/Downloads/bp102c15.pdf

Here is the exact language:

B. Therapy Students

1. General

Only the services of the therapist can be billed and paid under Medicare Part B.

The services performed by a student are not reimbursed even if provided under

“line of sight†supervision of the therapist; however, the presence of the

student “in the room†does not make the service unbillable. Pay for the

direct (one-to-one) patient contact services of the physician or therapist

provided to Medicare Part B patients. Group therapy services performed by a

therapist or physician may be billed when a student is also present “in the

roomâ€.

EXAMPLES:

Therapists may bill and be paid for the provision of services in the following

scenarios:

•    The qualified practitioner is present and in the room for the entire

session. The student participates in the delivery of services when the qualified

practitioner is directing the service, making the skilled judgment, and is

responsible for the assessment and treatment.

•    The qualified practitioner is present in the room guiding the student

in service delivery when the therapy student and the therapy assistant student

are participating in the provision of services, and the practitioner is not

engaged in treating another patient or doing other tasks at the same time.

•    The qualified practitioner is responsible for the services and as

such, signs all documentation. (A student may, of course, also sign but it is

not necessary since the Part B payment is for the clinician’s service, not for

the student’s services).

2. Therapy Assistants as Clinical Instructors

Physical therapist assistants and occupational therapy assistants are not

precluded from serving as clinical instructors for therapy students, while

providing services within their scope of work and performed under the direction

and supervision of a licensed physical or occupational therapist to a Medicare

beneficiary.

3. Services Provided Under Part A and Part B

The payment methodologies for Part A and B therapy services rendered by a

student are different. Under the MPFS (Medicare Part , Medicare pays for

services provided by physicians and practitioners that are specifically

authorized by statute. Students do not meet the definition of practitioners

under Medicare Part B. Under SNF PPS, payments are based upon the case mix or

Resource Utilization Group (RUG) category that describes the patient. In the

rehabilitation groups, the number of therapy minutes delivered to the patient

determines the RUG category. Payment levels for each category are based upon the

costs of caring for patients in each group rather than providing specific

payment for each therapy service as is done in Medicare Part B.

Rick Gawenda, PT

President

Gawenda Seminars & Consulting, Inc.

www.gawendaseminars.com

Follow Gawenda Seminars & Consulting, Inc on Facebook

Register for January 24, 2012 audio conference " 2012 Medicare & Private Payor

Updates " at

https://www.showmyevent.com/events/viewEventDetails.aspx?EventID=1735

Subject: Medicare part B and PT students

To: PTmanager

Date: Friday, January 6, 2012, 12:19 PM

 

List serve,

Please refresh my memory concerning the ability of PT students to see medicare

part B patients in the outpatient setting. I thought the student could work

with the medicare patient as long as the PT was within " line of sight " and did

not have other patients billed at that same time. I realize that the ruling has

changed over the years. thank you and Happy New Year.

Matt Dvorak, PT

Yankton, SD

[Guest guest]

Matt-

Outpatient Part B rules are still the strictest under Medicare. Services

provided by the students are NOT covered, because they are not qualified

practicioners. Under Medicare, only therapists ( and PTAs/ COPTAs under the

direction and supervision of the PT/OTR) are. " Line of sight " is not the

issue.

Therapists may bill and be paid for the provision of services as follows:

The qualified practitioner/therapist is present and in the room for the entire

session and is not engaged in treating another patient or doing other tasks at

the same time. The student may participate in the delivery of services but the

therapist is directing the service, making the skilled judgement and is

responsible for the assessment and treatment. Since the therapist is

responsible for the service, s/he signs all documentation.

We do have students actively treat our OP Medicare patients, under the direct

supervision and participation at all times by their CI/Therapist ( or PTA, for

PTA students). Since it is all 1:1 care ( or actually 2: 1 with the therapist

and student both there), and the therapists' role and responsibility in the

care is well documented, we have not had a problem with getting paid for these

services. Only once have we been denied because of student involvement ( knock

on wood) and that was because the CI forgot to sign the student's note-

Medicare DOES look!

Hope that helps.

Marcy Stalvey, PT, MS, NCS

Edwin Shaw Rehabilitation Institute

Cuyahoga Falls, OH 44221

From: PTManager [mailto:PTManager ] On Behalf Of

Matt Dvorak

Sent: Friday, January 06, 2012 12:19 PM

To: PTmanager

Subject: Medicare part B and PT students

List serve,

Please refresh my memory concerning the ability of PT students to see medicare

part B patients in the outpatient setting. I thought the student could work with

the medicare patient as long as the PT was within " line of sight " and did not

have other patients billed at that same time. I realize that the ruling has

changed over the years. thank you and Happy New Year.

Matt Dvorak, PT

Yankton, SD

[Guest guest]

Matt-

Outpatient Part B rules are still the strictest under Medicare. Services

provided by the students are NOT covered, because they are not qualified

practicioners. Under Medicare, only therapists ( and PTAs/ COPTAs under the

direction and supervision of the PT/OTR) are. " Line of sight " is not the

issue.

Therapists may bill and be paid for the provision of services as follows:

The qualified practitioner/therapist is present and in the room for the entire

session and is not engaged in treating another patient or doing other tasks at

the same time. The student may participate in the delivery of services but the

therapist is directing the service, making the skilled judgement and is

responsible for the assessment and treatment. Since the therapist is

responsible for the service, s/he signs all documentation.

We do have students actively treat our OP Medicare patients, under the direct

supervision and participation at all times by their CI/Therapist ( or PTA, for

PTA students). Since it is all 1:1 care ( or actually 2: 1 with the therapist

and student both there), and the therapists' role and responsibility in the

care is well documented, we have not had a problem with getting paid for these

services. Only once have we been denied because of student involvement ( knock

on wood) and that was because the CI forgot to sign the student's note-

Medicare DOES look!

Hope that helps.

Marcy Stalvey, PT, MS, NCS

Edwin Shaw Rehabilitation Institute

Cuyahoga Falls, OH 44221

From: PTManager [mailto:PTManager ] On Behalf Of

Matt Dvorak

Sent: Friday, January 06, 2012 12:19 PM

To: PTmanager

Subject: Medicare part B and PT students

List serve,

Please refresh my memory concerning the ability of PT students to see medicare

part B patients in the outpatient setting. I thought the student could work with

the medicare patient as long as the PT was within " line of sight " and did not

have other patients billed at that same time. I realize that the ruling has

changed over the years. thank you and Happy New Year.

Matt Dvorak, PT

Yankton, SD