Question: I am a PT working at an outpatient clinic (CORF) that is about to become Medicare certified. Currently, in addition to PTs, the clinic employs some exercise physiologists who provide direct care to patients. The exercise physiologists' treatments are billed under physical therapy codes. As PTs the clinic says we have to co-sign their notes and provide onsite supervision (this is in compliance with our state PT guidelines). It is my understanding from reading Medicare guidelines and from talking to CMS on the phone that this will need to change once we are Medicare certified. The way I understand it, only PTs can provide treatment to and bill for therapy services provided to Medicare patients. Do you know if this is correct?

When I brought this up to the clinic owners, they told me that this is not true and that they can either bill Medicare through our clinic director's license (a PT) or 'incident to' our medical director (a MD who is not onsite). They say that they are comfortable with their model because their exercise physiologists are highly trained. My understanding is, no matter how highly trained, they are unlicensed personnel in the eyes of Medicare and cannot provide direct therapy services and bill for Medicare treatments.

These owners have several clinics (in other states than mine) and say that they have passed Medicare certification with their current rehab model in these other states. I don't know how detailed this certification process is and, if this activity is against Medicare guidelines, if it would have been discovered and disallowed.

I would REALLY appreciate any information that you can provide me about this situation, including links, written material and/or phone numbers for experts on this matter. I would also appreciate your thoughts and recommendations. As a therapist, I want to make sure that I do not participate in any activities that violate Medicare guidelines. I would appreciate it if you would not share my name or contact information, since I will possibly be losing/leaving my job over this matter.

Answer: You are absolutely correct in your interpretation of Medicare guidelines. To utilize exercise physiologists to provide services to ANY Medicare beneficiary is not compliant with Medicare regulations and therefore is Medicare fraud. Even if you co-sign the exercise physiologists' notes, it may meet your State Practice Act but it in no way compliant with Medicare regulations.

In June, 2005 Medicare changed its regulations and indicated that only a licensed physical therapist or a person with the equivalent training as a physical therapist but without the license could treat their patients and bill the program under 'incident to' rules.

It sounds to us that it would be advisable to leave this company and find one that treats its patients in compliance with Medicare regulations. As an aside, are you really comfortable with an exercise physiologist treating patients and documenting care? Even if it is allowed under your State Practice Act, aren't you undercutting your professional standards?

Question: I am a physical therapist assistant and working in an outpatient setting in the Florida. My question is: Do I need a physical therapist on site in order to treat patients?

Answer: Under the Florida Practice Act you only require the general supervision of the therapist. This means that you must be able to contact your supervisor through any electronic or telephonic means when you are treating patients. As far as Medicare is concerned it has the same requirements of general supervision in all provider settings with the exception of PTs in private practice.

Pauline M. Franko, PT is owner of Encompass Consulting & Education, LLC; a consulting and education company specializing in Medicare 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.