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The analysis of any legal or medical billing is dependent on numerous specific facts — including the factual situations present related to the patients, the practice, the professionals and the medical services and advice. Additionally, laws and regulations and insurance and payer policies are subject to change. The information that has been accurate previously can be particularly dependent on changes in time or circumstances. The information contained in this web site is intended as general information only. It is not intended to serve as medical, health, legal or financial advice or as a substitute for professional advice of a medical coding professional, healthcare consultant, physician or medical professional, legal counsel, accountant or financial advisor. If you have a question about a specific matter, you should contact a professional advisor directly. CPT copyright American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.

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Ohio Medicaid Outpatient Therapy 

Guidelines for Ohio Medicaid coverage of outpatient therapy services.  If the client is enrolled in a managed care plan some of the rules may be different but coverage will be the same.  Members have full access to the material and can email us regarding any billing or compliance issue, please consider joining today if you need additional assistance.  

Eligible Providers

  • Who may provide therapy services?
  • Who may bill for therapy services?
  • Who may independently bill for therapy services?
  • Does the provider need to be enrolled in the Medicaid program?

Documentation

    • Can an evaluation be performed on the same day as treatment?
    • Is there a limit on the number of evaluations that can be done per injury or condition?
    • What must be included in the evaluation?
    • When is a reevaluation required?
    • What is required in the treatment plan?
    • What is required in the progress summary?


Coverage Criteria

    • How many therapy visits can be provided within a year before prior authorization is needed?
    • Is a prescription required for therapy?
    • Who can prescribe therapy services?
    • What are the criteria for justifying rehabilitative potential?
    • What are the criteria for justifying developmental potential?
    • How is reimbursement handled if more than one skilled therapy service of the same discipline is rendered by the same provider or provider group to a recipient on the same date?
    • Which services are not covered?

About Us

Therapy Comply is a healthcare compliance firm that seeks to bring high quality web-based compliance guidance and one-on-one consulting services to small and medium size physical, occupational, and speech therapy practices.

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Join today as either a monthly or a yearly member and enjoy full access to the site and a significant discount to our live and recorded webinars.  Members also have access to compliance and billing support.

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