Question: I am a physical therapist in a private outpatient physical therapy clinic in Illinois. I am the company's Medicare compliance officer, and have a question on what a technician can do in the clinic and what can be billed. I know that a technician can perform ultrasound on Medicare patients, but can we bill for it if the supervising therapist is working with another patient? Can we bill for the time a technician is supervising a patient performing exercises while the supervising therapist is working with another patient?
Answer: Apparently, you a not completely familiar with Medicare Part B regulations which govern outpatient physical therapy clinics as well as every other practice setting providing Part B coverage. Medicare does not reimburse for the services of a physical therapy technician delivering direct one-on-one services to a Medicare beneficiary in an outpatient setting.
Under Part B, which pays for outpatient therapy services, Medicare pays only for the skilled services of a physical therapist or a physical therapist assistant. Medicare considers both ultrasound and exercise as direct one-on-one services that must be delived by a licensed therapist or therapist assistant. Thefore, ultrasound and exercise performed by a physical therapy technician cannot be billed to Medicare Part B. If you do it is Medicare fraud!
We applaud your company appointing a Medicare compliance officer. As you probably know, it is not a Medicare requiment, but is a practice that is strongly encouraged by Medicare. We hope that your company will give you time to address the Medicare regulations available free on the Internet. We commend you start with the Coverage of Service regulations in Publication 100-02, Medicare Benefits Policy available at www.cms.hhs.gov/manuals/
Please allow us a moment on our soapbox: We are aware that many therapists allow technicians to perform ultrasound treatment. However, we want to strongly discourage this practice. Ultrasound is a very useful modality, but it is also dangerous in the hands of unskilled personnel. We believe that ultrasound should be left to the professionals.
Question: With regard to your column on Dec. 20, 2004, we have a question. Is a private practice always synonymous with an outpatient physical therapy clinic?
Answer: The answer is no. The term private practice can have two meanings under Medicare regulations. Private practice can mean an individual physical therapist or occupational therapist who has obtained an individual provider number from Medicare as a Therapist in Private Practice, commonly referred to as PTPP (physical therapist in private practice) or OTPP (occupational therapist in private practice).
A private practice can also mean that several private practice therapists have merged to form a group practice. In this case, the therapists have assigned their Medicare number to the group practice. This group practice may be doing business an outpatient physical therapy clinic. The other scenario is that an outpatient clinic, under Medicare, is a corporation that has its own provider number. In this situation, therapists do not have their own individual provider number, as they are employees of the company.
If you have a question about Medicare reimbursement you would like the authors to address, send your question and contact information to Medicare Advisor, c/o Linda Jones, ADVANCE for PTs & PTAs, 2900 Horizon Dr., King of Prussia, PA 19406; fax 610-278-1425; email@example.com
Pauline Franko and Danna Mullins are the principal lecturs for Encompass Consulting and Education LLC, a rehabilitation consulting and education company in Tamarac, FL. You may contact the authors through their Website at www.encompassmedicare.com