Reimbursement and PTA supervision Flashcards
What does supervision of a PTA look like in hospitals or other clinical settings?
- Require constant onsite supervision
- A joint treatment with the PT and PTA or a direct treatment by the PT with a conference between the PT and PTA must occur at least ONCE PER WEEK
What does supervision of a PTA look like in schools, home-health, and long term care?
- PT must be available by communication to PTA at all times during treatment
- Initial visit and establishment of plan of care by PT
- Joint visit or conference with PT and PTA on or before first visit by PTA
- At least once every 6th PTA visit or every 30 calendar days (whichever comes first) the PT needs to make a visit
- Supervisory visit must include: functional onsite assessment, review of activities with appropriate modifications or termination of plan of care (with documentation), and assessment of utilization of outside resources
how long just minors’ medical records be kept?
until the child reaches 21 years plus the states statute of limitations
- statute of limitations - medicare requires 5 years, but most states keep 10 years
What are potential exclusions of related services that won’t be covered?
- sub malleolar orthotics
- maintenance therapy
- fitness equipment
- bikes, bathroom equipment
- wellness
and more…
DME usually has an annual max dollar amount set. What are potential examples that could be covered?
- orthotics
- wheelchairs
- TLSO’s
and more of those things..
Is maintenance therapy covered?
depends; some policies will allow for X visits for HEP instruction with maintenance care
What are the 5 questions you must answer while writing functional goals?
- Who
- Will do what
- Under what condition
- How Well
- By when
What are the ABC’s of goal writing?
Audience Behavior Condition Degree Emphasize Function
What are reasons for denial?
- Expiration of the policy
- Exhaustion of the benefit
- Noncovered/Exclusionary Service
- Not Medically Necessary
- Lifetime Cap; Consideration during Plan of Care; Opportunity to access additional funding sources
- No referral - if medicaid
Who funds medicaid programs
both federal and state government
True or false: PT is a federally mandated Medicaid service.
False
- it is not; a state can choose to allow as few as 0 PT visits for a Medicaid policy
- for children though, it IS a federally mandated service
Who is eligible for medicaid?
eligibility is determined by:
- Income
- disability
- if they are a child
- eligibility parameters are determined state by state
If a child has Medicaid as a secondary insurance is it billed 1st or 2nd?
2nd
- medicaid is a payer of last resort
If a child has Medicaid as a secondary insurance will the patient be responsible for any portion of their payment?
No, their visit will be completely paid for unless the state determines they will not cover physical therapy as a mandated service, the treatment, or DME is deemed not medically necessary
Models of _____ ______ allow for integration of knowledge, research, and assumptions in a clinically relevant fashion that ultimately leads to evidence-based decision making
service delivery
- team approach: Multi vs. trans/primary service provider
Individual discipline-specific assessments of a specific developmental area; Discipline-specific treatments; Discipline-specific goals and objectives
Multidisciplinary
- Disadvantages:
1. Least effective
2. Fragmented care
3. Poor communication between team members
4. Lost opportunities in other developmental areas
5. Lots of providers in the home
6. Not Family Friendly
Team discipline specific assessments; Cooperative treatments; however each team member continues to be primarily responsible for their area of expertise; Discipline specific goals and objective with input and awareness from all team members
Interdisciplinary
- Advantages:
1. Improved communication
2. Awareness for other disciplines
3. Elimination of lost opportunities
4. Continue to have lots of expertise - Disadvantages:
1. Lots of providers
2. Borderline family friendly
Development is viewed as an integrated process; Generally team discipline specific evaluation; Cooperative goal writing and treatment plan development among all team members (including families); Primary service provider - Main person providing early intervention services who is typically chosen based on child’s greatest area of need, and should regularly be re-evaluated and possibly changed; NOT intended to be a cost-saving method
Transdisciplinary/ primary service provider
- Research supports this model as the ideal model for learning in infants and young children (birth-3)
- Advantages:
1. Family friendly
2. Eliminates lost opportunities - Disadvantages:
1. Most difficult to accurately incorporate
2. Often times used as a cost savings method or in cases of therapist shortages
3. Difficult for parents and professionals to understand
4. Requires lots of regular communication
5. Not easy for new graduates (requires lots of mentorship)
6. Some need for role release
7. Watch for scope of practice issues
What settings can PTAs practice without onsite supervision?
- schools
- home health
- SNFs
- PT must be available by communication at all times during tx
Can PTAs perform gentle handling to promote alertness and state control to prepare for bottling with the RN with a 2 week old infant in the NICU?
No. PTAs can’t work in the NICU because of the rapid examination and changing status of babies
- NICU is not a place for entry level PTs
- PTAs cannot work in ICUs either due to unstable patient
