Question: We have reviewed your article in ADVANCE in the Jan. 30, 2006 issue. In reference to the co-treat question, we are asking for clarification. The MDS manual is for skilled services only. Are you stating the same regulations are for Medicare Part A patients on any unit of a hospital? Where could we access a current 2006 RAI manual? Also where would we find the Medicare Part B regulations for outpatient to reference co-treatment?

Answer: The regulations contained in the RAI Manual are for skilled nursing facilities (SNF) only. Each site for providing Part A services (e.g., hospital, inpatient rehabilitation facilities, SNF, home health) work under their own particular regulations, and have their own manual. The regulation under SNF does not apply to other sites of service. 

As far as hospitals go, the regulations in the Hospital Manual covering therapy services are meager at best. Our apologies for the incorrect web address; CMS has changed its Website. The new location for all Part B references including the therapy caps is www.cms.hhs.gov/TherapyServices

Question: I am employed by a hospital and perform outpatient PT in an area leased from the hospital's wellness center. In this wellness center, I also have the availability of a 4,500 square-foot pool. Under the current lease agreement, I "rent the use of the pool" in 30-minute increments. 

My question is: Can I bill Medicare for aquatic therapy for my patients, if other pool users are in the pool when I am treating my aquatic therapy patients? My CFO informed me that since the wellness center is owned by the hospital, private practioner rules and regulations do not apply. I am worried that I should not be billing Medicare for aquatic therapy if other wellness member (not patients) is also utilizing the pool. Could I section off a portion of the pool for my patients, or should my "rental agreement" be all inclusive of the entire wellness facility? I have been trying to contact our FI with no success. 

Answer: The regulations that you are referring to are related to the therapist in private practice and are found in the Part B regulations Pub: 100-2 Chapter 15 - Covered Medical and Other Health Services, §230.4 A. For the therapist in private practice, the therapist must rent the space exclusively so that the pool becomes an extension of their own practice.

You are an employee of the hospital, and the pool is owned by the hospital. We can find nothing in the regulations that would require you to follow the rules for a therapist in private practice to provide aquatic therapy. 

The rental agreement you refer to appears to be more of an accounting practice for your own hospital than a lease between a therapist and the hospital to use their pool space. The wellness center is either part of the hospital (and therefore an extension of their outpatient department), or it is licensed as its own free standing outpatient facility. Either way, you have a "clinic," and Medicare regulations do not require therapists in these sites of service have a Medicare-only treatment area.

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 Lisa Lombardo, ADVANCE for PTs & PTAs, 2900 Horizon Dr., King of Prussia, PA 19406; fax 610-275-8562; llombardo@merion.com

Pauline Franko is owner and principal lecturer for Encompass Consulting & Education, LLC, a rehabilitation consulting and education company producing the "Medicare Made Easy" Series, (see our ad in the current issue of ADVANCE); Danna Mullins is an associate and lecturer. You may contact the authors through their Website at www.encompassmedicare.com