Question: Can a PTA in a freestanding, outpatient facility treat Medicare patients if a PT is not in the clinic, but available as needed by phone at another site or at home (on days off, etc.)? My understanding has always been that a PT must be available by telecommunication, but does not have to be on site in order for a PTA to treat a patient.
Recently, a PT friend of mine attended a continuing education course where it was stated very firmly that PTAs must have direct supervision by a physical therapist on site when providing care, and that Medicare has been lax about enforcing this rule until recently. The course participants were told that Medicare had begun fining huge amounts for those who broke this rule and, of course, PT licenses were in jeopardy. As you can imagine, the therapists at the course were concerned. I had never heard of such a thing before and am concerned about clinics owned by PTAs who hire PTs part-time, and have full-time PTAs on staff who are there alone a significant amount of time, and clinics who split the schedule for early hours and late hours where one to two hours/day, there is no PT.
Is there really such a rule about supervising PTAs directly? If so, where do I find these regulations?
Answer: Medicare does have supervision requirements for PTAs. The regulation you refer to is ONLY applicable to therapists in private practice (PTPP). For PTPP, the regulations state that direct supervision must occur in order to bill Medicare for the services provided by anyone other than the PTPP who has the provider number. Direct supervision means that the therapist must be in the same office suite and be immediately available to provide assistance when necessary. Also included is the requirement that the supervising therapist provides at least one billable treatment every tenth visit or 30 days, whichever is the least, when the assistant is providing treatment.
The direct supervision requirements for PTPPs ALSO apply to a licensed PT (without their own Medicare provider number) who works for the PTPP. The requirement for the PTPP to provide treatment every tenth visit does not apply when a licensed therapists is providing the care to the patient. However, the PTPP must be on premise when services are being provided (in order to bill the Medicare program). Also remember that you need to look at your State Practice Guidelines. If they are more stringent than Medicare's you must abide by those regulations, that is when a license comes under jeopardy.
These regulations about the PTPP can be found in the CMS IOM (Internet Only Manual) Pub. 100-02, Chapter 15, §230.4 B. www.cms.hhs.gov/manuals/IOM/list.asp
Medicare has always indicated, for any site of services, that, if the supervision requirements are not met, then the claim can be denied AND the claim be referred to the regional office for review. This usually leads to denials of claims.
For all other sites of services for outpatient therapy, general supervision of the assistant is required. In the situation you describe in your question, you are most likely talking about a rehab agency, and rehab agencies do not come under the direct supervision requirement.
Hopefully this helps alleviate your fears.
Pauline M. Franko, PT is owner of Encompass Consulting & Education, LLC; a consulting and education company specializing in Medicare Consulting, Compliance and Training, based in Tamarac, FL. The company's "Direction on Demand" service specializes in providing the rehabilitation professional with a clear, easy way to understand how to provide Medicare compliant services to their patients in the SNF and Outpatient settings. As an associate in Comprehensive Medicare Consultants, LLC, she is responsible for assisting with and directing compliance programs to Rehab Agencies. Danna Mullins is an associate and lecturer with Encompass. You may contact the authors through the Encompass website at www.encompassmedicare.com or by phone at 954-720-4087.