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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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  • 13 Jul 2021 12:05 PM | Zachary Edgar (Administrator)

    Scope of Practice

    • How is physical therapy defined in Texas?
    • What is included in the practice of physical therapy?
    • What is specifically excluded from the practice?
    • Are there any special trainings or requirements?

    Direct Access and Referrals 

    • When can a PT treat a patient without a referral?
    • Patient consent to be treated without a referral
    • Which providers can issue the referral?
    • Methods of referral

    Supervision and Delegation

    • Supervision Definitions
    • Which services can only be performed by a PT?
    • What are the responsibilities of the PT when delegating?

    Assistants

    • What services are PTAs allowed to perform?
    • Are there specific services that PTAs are prohibited from practicing?
    • What type of supervision is required?
    • Does the supervising physical therapist need to co-sign documentation created by the PTA?
    • Is a reevaluation or reassessment required?
    • What is the ratio between supervising PTs and PTAs?
    • Required designation for assistants

    Aides

    • What can an aide do?
    • What is an aide expressly prohibited from doing?
    • What type of supervision is required?
    • What is the ratio between supervising PTs and aides?
    • Required designation for aides

    Documentation 

    • What must be included in the patient record?
    • What are the PT’s documentation responsibilities?
    • When is a reevaluation/reassessment required?
    • Discharge Summary

    Designations and Notifications

    • How can I use “Dr” in my title?
    • Are there any specific requirements for posting notifications or licenses?
    • Consumer Information Sign
    • When does a PT have to notify the board of any information changes?


    Continuing Education

    • How many continuing education hours are required during a reporting period?
    • Can CE credits be carried over into the next reporting period?
    • Are there any specific courses that must be taken?
    • What types of activities can be used for the continuing education requirements?
    • What type of approval is needed for the courses?
    • What are the reporting requirements?
    • Waivers and audits 

    Telehealth

    • Licensure
    • Technology
    • Standard of Care
    • Informed Consent
    • Confidentiality

    Graduate and Student Practice

    • Can students practice in a clinical setting?
    • What kind of supervision is required for student PTs and PTAs?
    • How must students identify themselves?
    • What type of license/permit must new graduates receive before practicing?
    • Eligibility
    • What kind of supervision is required?
    • Duration of the temporary license

    Out-of-State PTs and PTAs

    • Situations where an out-of-state PT/PTA can practice in Texas

    License by Endorsement

    • Who is eligible for a license by endorsement?
    • What is required for the application?
    • Licensure for a Military Service Member
    • Provisional Licensure

    Educational and Early Intervention Settings

    • Services which may require a physician’s referral
    • Evaluation and reevaluation
    • Role of the PT in Early Childhood Intervention settings
    • Services which require a referral
    • Evaluation and reevaluation

    Unprofessional Conduct 

    • Practice in manner detrimental to public health and welfare
    • When am I obligated to report to the board?
    • Additional grounds for discipline
    • Gross negligence


  • 24 Jun 2021 2:02 PM | Zachary Edgar (Administrator)

    An Advanced Beneficiary Notice of Noncoverage (ABN) is a form given to the Medicare patient before performing healthcare services that the provider knows are not covered or that the provider thinks may not be covered by the Medicare program.   The form is used to serve as notice to the patient that 1) the service is not covered and 2) that they will be liable to pay for the service. 

    When it is Mandatory to Issue an ABN?

    When it is Voluntary to Issue an ABN?

    Triggering Events (When to give the patient the ABN)

    • Initiations
    • Reductions
    • Terminations
    Issuing the ABN

    ABN Form and Instructions

    • Header
    • Body
    • Options
    • Additional Information
    • Signature Box

    ABN Preparation Requirements

    • Language Choice
    • Effective Versions
    • Number of Copies
    • Reproduction
    • Length and Size of Page
    • Contrast of Paper and Print
    • Font
    • Customization
    • Modification
    • Retention Requirements

    ABN Notice and Delivery

    • Proper Notice Requirements
    • Readability Requirements
    • Specificity, Delivery, and Receipt
    • Defective Notice
    • Timeliness
    • Effective Delivery
    • Telephone Notice
    • Capable Recipient
    • Authorized Representatives

    Routine Notice Prohibitions and Exceptions

    • Generic ABNs
    • Blanket ABNs
    • Signed Blank ABNs
    • Exceptions
    ABN Modifiers


  • 21 Jun 2021 4:38 PM | Zachary Edgar (Administrator)

    Florida Occupational Therapy

    Continuing Education

    • How many continuing education hours are required during a reporting period?
    • How is credit hour defined?
    • How long is the reporting period?
    • Can CE credits be carried over into the next reporting period?
    • Are there any specific requirements for continuing education?
    • What types of activities can be used for the continuing education requirements?
    • What type of approval is needed for the courses?
    • How long must continuing education records be retained?

    Scope of Practice

    • How is occupational therapy defined in Florida?
    • What is included in the practice of occupational therapy?
    • What is specifically excluded from the practice?
    • Are there any special trainings or requirements?

    Electrical Stimulation Devices

    • Required Training
    • Supervised Treatment Sessions
    • Minimum Competency Levels

    Ultrasound Devices

    • Required Training
    • Supervised Treatment Sessions
    • Minimum Competency Levels

    Neurofeedback Devices

    • Required Training
    • Supervised Treatment Sessions
    • Minimum Competency Levels

    Assistants

    • What type of supervision is required?
    • Does the supervising OT need to be present?
    • Does the supervising occupational therapist need to co-sign documentation created by the OTA?
    • What is the ratio between supervising OTs and OTAs?

    Aides

    • How is an aide defined?
    • What can an aide do?
    • What is an aide expressly prohibited from doing?
    • What are the responsibilities of the OT when delegating to an aide?
    • What type of supervision is required?
    • What is the ratio between supervising OTs and aides?
    • Required designation for aides

    Students 

    • Can students practice in a clinical setting?
    • How must students identify themselves?

    Unprofessional Conduct 

    • Reporting Obligations
    • Prohibitions
    • Fee Splitting


  • 20 Jun 2021 3:31 PM | Zachary Edgar (Administrator)

    Continuing Education 

    • How many continuing education hours are required during a reporting period?
    • Can CE credits be carried over into the next reporting period?
    • Are there any specific courses that must be taken?
    • What types of activities can be used for the continuing education requirements?
    • What type of approval is needed for the courses?
    • What are the reporting requirements?
    • Waivers and audits 

    Scope of Practice

    • How is the practice of Occupational Therapy defined in Maryland?
    • What services are included in the scope of practice?
    • Services specifically excluded from the scope of practice
    • Are there any specific procedures or modalities regulated by the board?

    Physical Agent Modalities

    • Definitions
    • Standards of Competence for Electrical Modalities
    • Didactic Education
    • Clinical Requirements
    • Documentation of Education
    • Treatment Plan Guidelines for Physical Agent Modalities
    • Superficial Physical Agent Modalities
  • 10 Jun 2021 2:49 PM | Zachary Edgar (Administrator)

    HIPAA Guides and FAQs

    HIPAA Basics

    The Security Rule

    Breach Notifications

    The Privacy Rule

    Business Associates 

    Sample Forms and Agreements - A collection of notices, forms, policies and procedures that can be used by small and medium healthcare providers to supplement their existing material.

  • 7 Jun 2021 1:37 PM | Zachary Edgar (Administrator)

    See our NCCI page for more information. 

  • 19 Apr 2021 2:20 PM | Zachary Edgar (Administrator)

    Continuing Education

    • How many continuing education hours are required during a reporting period?
    • Can CE credits be carried over into the next reporting period?
    • Are there any specific courses that must be taken?
    • What types of activities can be used for the continuing education requirements?
    • What type of approval is needed for the courses?
    • What are the reporting requirements?
    • Waivers and audits 

    Scope of Practice

    • How is the practice of Physical Therapy defined in New Jersey?
    • What is included in the practice of physical therapy?
    • Definitions related to diagnostic testing
    • Examinations and evaluations
    • Services specifically excluded from the scope of practice
    • Are there any specific procedures or modalities regulated by the board?

    Telehealth

    • Definitions
    • License requirements
    • Standard of Care
    • PT/PTA Patient Relationship
    • Provision of Services through Telehealth
    • Records
    • Prevention of Fraud and Abuse
    • Privacy and Notice to Patient

    Orders and Referrals

    • Is a referral required to provide PT services?
    • Exceptions to the referral requirement?
    • When does a PT have to refer a patient to a physician?

    Delegation and Supervision

    • Supervision Definitions
    • What are the responsibilities of the PT when providing direct supervision?
    • What are the responsibilities of the PT when providing general supervision?

    Assistants

    • Which services are PTAs allowed to practice?
    • Are there specific services that PTAs are prohibited from practicing?
    • What type of supervision is required?
    • When the supervising physical therapist is off-site
    • What are the assistant’s documentation responsibilities?
    • Does the supervising physical therapist need to co-sign documentation created by the PTA?
    • What is the ratio between supervising PTs and PTAs?
    • What is the required designation for assistants?

    Aides

    • What can an aide do?
    • What is an aide expressly prohibited from doing?
    • What are the responsibilities of the PT when delegating to an aide?
    • What type of supervision is required?

    Documentation 

    • What must be included in the patient record?
    • What are the physical therapist’s documentation responsibilities?
    • Exception to the documentation requirements
    • How long do the records need to be retained?
    • Release of patient records
    • Charging the patient for copies
    Identification and Notification
    • PT and PTA Identification
    • Are there any specific requirements for posting notifications or licenses?
    • When does a PT have to notify the board of any information changes?

    Advertising

    • Definitions related to advertising
    • Misconduct related to advertising
    • Advertising fees
    • Advertising certification in a specialty area
    • Advertising free or discounted services
    • Testimonial advertising
    • Minimum content requires in all advertising
    • Business entities offering physical therapy services
    • Retaining advertising records

    Financial Arrangements with Patients

    • Reasonable fees
    • Required information on patient fees
    • Disallowed fees
    • Excessive fees

    Temporary License

    • Duration of the temporary license
    • Renewal
    • Responsibilities of a temporary visiting PTA

    Unprofessional Conduct 


  • 5 Apr 2021 5:01 PM | Zachary Edgar (Administrator)

    PTP Edits-Practitioners: These PTP code pair edits are applied to claims submitted by physicians, non-physician practitioners, and Ambulatory Surgery Center (ASCs). These edits also apply to therapists in private practice and those employed by physicians. 

    Updated: April 1, 2021

    Physical and Occupational Therapy Evals and Reevals

    • PT Eval; low complexity
    • PT Eval; med complexity
    • PT Eval; high complexity
    • PT Reevaluation
    • OT Eval; low complexity
    • OT Eval; med complexity
    • OT Eval; high complexity
    • OT Reevaluation

    Therapeutic Procedures

    • Therapeutic Exercise
    • Neuromuscular Reeducation
    • Aquatic Therapy
    • Gait Training
    • Massage Therapy
    • Therapeutic Intervention; 15 min
    • Therapeutic Intervention; add 15 min
    • Physical Medicine Procedure
    • Manual Therapy
    • Group Therapy
    • Therapeutic Activities
    • Sensory Integrative Techniques
    • Self-Care Management
    • Community/Work Integration
    • Wheelchair Management Training
    • Work Hardening

    Modalities

    • Biofeedback Modality
    • Biofeedback Training; initial 15 minutes
    • Biofeedback Training; each additional 15 minutes
    • Hot or Cold Packs
    • Mechanical Traction
    • Vasopneumatic Devices
    • Paraffin Bath
    • Whirlpool
    • Diathermy
    • Ultraviolet
    • Electrical Stimulation (manual)
    • Iontophoresis
    • Contrast Baths
    • Ultrasound
    • Hydrotherapy
    • Electrical Stimulation (unattended)
    • Electrical Stimulation (Non wound)

    Assessments and Orthotics/Prosthetics

    • Range of Motion Measurements
    • Range of Motion; hand
    • Canalith Repositioning
    • Cognitive Testing HC Pro
    • Physical Performance Test
    • Assistive Technology Assessment
    • Orthotic Management
    • Prosthetic Management
    • Orthotic/Prosthetic Management

    Wound Care

    • Removal Devitalized Tissue 20cm/<
    • Removal Devitalized Tissue addl 20 cm<
    • Wound Care (non-selective
    • Negative Press Wound tx < 50 cm
    • Negative Press Wound tx > 50 cm
    • Negative Press Wound tx </=50 sq cm
    • Negative Press Wound tx >50 cm
    • Low Frequency, Non-Contact, Ultrasound


  • 5 Apr 2021 5:00 PM | Zachary Edgar (Administrator)

    PTP Hospital edits are applied to Types of Bills (TOBs) subject to the Outpatient Code Editor (OCE) for OPPS. These edits are applied to outpatient hospital services and other facility services including, but not limited to, therapy providers (Part B Skilled Nursing Facilities (SNFs)), comprehensive outpatient rehabilitation facilities (CORFs), outpatient physical therapy and speech-language pathology providers (OPTs), and certain claims for home health agencies (HHAs) billing under TOBs 22X, 23X, 75X, 74X, 34X.

    Updated: April 1, 2021

    Physical and Occupational Therapy Evals and Reevals

    • PT eval; low complexity
    • PT eval; med complexity
    • PT eval; high complexity
    • PT Reevaluation
    • OT Evaluation; low complexity
    • OT Evaluation; med complexity
    • OT Evaluation; high complexity
    • OT Reevaluation

    Therapeutic Procedures

    • Therapeutic Exercise
    • Neuromuscular Reeducation
    • Aquatic Therapy
    • Gait Training
    • Massage Therapy
    • Therapeutic Intervention; 15 min
    • Therapeutic Intervention; add 15 min
    • Physical Medicine Procedure
    • Manual Therapy
    • Group Therapy
    • Therapeutic Activities
    • Sensory Integrative Techniques
    • Self-Care Management
    • Community/Work Integration
    • Wheelchair Management Training
    • Work Hardening

    Modalities

    • Biofeedback Modality
    • Biofeedback Training; initial 15 minutes
    • Biofeedback Training; each additional 15 minutes
    • Hot or Cold Packs
    • Mechanical Traction
    • Vasopneumatic Devices
    • Paraffin Bath
    • Whirlpool
    • Diathermy
    • Ultraviolet
    • Electrical Stimulation (manual)
    • Iontophoresis
    • Contrast Baths
    • Ultrasound
    • Hydrotherapy
    • Electrical Stimulation (unattended)
    • Electrical Stimulation (Non wound)

    Assessments and Orthotics/Prosthetics

    • Range of Motion Measurements
    • Range of Motion; hand
    • Canalith Repositioning
    • Cognitive Testing HC Pro
    • Physical Performance Test
    • Assistive Technology Assessment
    • Orthotic Management
    • Prosthetic Management
    • Orthotic/Prosthetic Management

    Wound Care

    • Removal Devitalized Tissue 20cm/<
    • Removal Devitalized Tissue addl 20 cm<
    • Wound Care (non-selective
    • Negative Press Wound tx < 50 cm
    • Negative Press Wound tx > 50 cm
    • Negative Press Wound tx </=50 sq cm
    • Negative Press Wound tx >50 cm
    • Low Frequency, Non-Contact, Ultrasound 


  • 5 Apr 2021 3:22 PM | Zachary Edgar (Administrator)

    Practitioner Edits apply to therapists in private practice and employed by physician groups.

    Hospital Edits apply to therapists working in facilities such as outpatient hospitals, CORFs, outpatient rehabilitation, and SNFs.

    Updated: April 5, 2021

    Medically Unlikely Edits (MUE) Guide

    MUE Practitioner Edits - April 1, 2021

    MUE Practitioner Edits - January 1, 2021

    MUE Hospital Edits - April 1, 2021

    MUE Hospital Edits - January 1, 2021


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