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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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  • Alabama Occupational Therapy Scope of Practice

    24 Oct 2021 2:45 PM | Zachary Edgar (Administrator)

    How is occupational therapy defined in Alabama?

    The practice of occupational therapy means the therapeutic use of occupations, including everyday life activities with individuals, groups, populations, or organizations to support participation, performance, and function in roles and situations in home, school, workplace, community, and other settings.

    Occupational therapy services are provided for habilitation, rehabilitation, and the promotion of health and wellness to those who have or are at risk for developing an illness, injury, disease, disorder, condition, impairment, disability, activity limitation, or participation restriction.

    Occupational therapy addresses the physical, cognitive, psychosocial, sensory-perceptual, and other aspects of performance in a variety of contexts and environments to support engagement in occupations that affect physical and mental health, well-being, and quality of life.

    What is included in the practice of occupational therapy?

    Evaluation of factors affecting activities of daily living (ADL), instrumental activities of daily living (IADL), rest and sleep, education, work, play, leisure, and social participation including all of the following:

    • Client factors, including body functions, such as neuromusculoskeletal, sensoryperceptual, visual, mental, cognitive, and pain factors; body structures such as cardiovascular, digestive, nervous, integumentary, genitourinary systems, and structures related to movement; values, beliefs, and spirituality.
    • Habits, routines, roles, rituals, and behavior patterns.
    • Physical and social environments, cultural, personal, temporal, and virtual contexts, and activity demands that affect performance.
    • Performance skills, including motor and praxis, sensory-perceptual, emotional regulation, cognitive, communication, and social skills.

    Methods or approaches selected to direct the process of interventions such as:

    • Establishment, remediation, or restoration of a skill or ability that has not yet developed, is impaired, or is in decline.
    • Compensation, modification, or adaptation of activity or environment to enhance performance, or to prevent injuries, disorders, or other conditions.
    • Retention and enhancement of skills or abilities without which performance in everyday life activities would decline
    • Promotion of health and wellness, including the use of self-management strategies, to enable or enhance performance in everyday life activities.
    • Prevention of barriers to performance and participation, including injury and disability prevention.

    Interventions and procedures to promote or enhance safety and performance in activities of daily living (ADL), instrumental activities of daily living (IADL), rest and sleep, education, work, play, leisure, and social participation including all of the following:

    • Therapeutic use of occupations, exercises, and activities.
    • Training in self-care, self-management, health management and maintenance, home management, community/work reintegration, and school activities and work performance.
    • Development, remediation, or compensation of neuromusculoskeletal, sensory-perceptual, visual, mental, and cognitive functions, pain tolerance and management, and behavioral skills.
    • Therapeutic use of self, including one's personality, insights, perceptions, and judgments, as part of the therapeutic process.
    • Education and training of individuals, including family members, caregivers, groups, populations, and others.
    • Care coordination, case management, and transition services.
    • Consultative services to groups, programs, organizations, or communities.
    • Modification of environments, including home, work, school, or community, and adaptation of processes, including the application of ergonomic principles.
    • Assessment, design, fabrication, application, fitting, and training in seating and positioning, assistive technology, adaptive devices, training in the use of prosthetic devices, orthotic devices, and the design, fabrication and application of selected splints or orthotics.
    • Assessment, recommendation, and training in techniques to enhance functional mobility, including management of wheelchairs and other mobility devices.
    • Low vision rehabilitation when the patient or client is referred by a licensed optometrist, a licensed ophthalmologist, a licensed physician, a licensed assistant to physician acting pursuant to a valid supervisory agreement, or a licensed certified registered nurse practitioner in a collaborative practice agreement with a licensed physician.
    • Driver rehabilitation and community mobility.
    • Management of feeding, eating, and swallowing to enable eating and feeding performance.
    • Application of physical agent modalities, and use of a range of specific therapeutic procedures such as wound care management, interventions to enhance sensory-perceptual and cognitive processing, and manual therapy, all to enhance performance skills.
    • Facilitating the occupational performance of groups, populations, or organizations through the modification of environments and the adaptation of processes.

    What is specifically excluded from the practice?

    N/A

    Are there any special trainings or requirements?

    N/A

    Reference

    Ala. Code §34-39-3

  • Alabama Physical Therapy Scope of Practice

    24 Oct 2021 2:42 PM | Zachary Edgar (Administrator)

    How is the practice of Physical Therapy defined in Alabama?

    The treatment of a human being by the use of exercise, massage, heat, cold, water, radiant energy, electricity, or sound for the purpose of correcting or alleviating any physical or mental condition or preventing the development of any physical or mental disability, or the performance of neuromuscular-skeletal tests and measurements to determine the existence and extent of body malfunction.

    What services are included in the scope of practice?

    N/A

    Services specifically excluded from the scope of practice

    Physical therapy does not include radiology or electrosurgery.

    Are there any specific procedures or modalities regulated by the board?

    Yes. October 23, 2007: Board Minutes: Acupuncture & Dry Needling does fall within the scope of practice for physical therapy.

    Reference

    Ala. Code 34-24-191


  • Arizona Speech Therapy Scope of Practice

    14 Oct 2021 3:49 PM | Zachary Edgar (Administrator)

    How does Arizona define the practice of speech-language pathology?

    "Speech-language pathology" means the nonmedical and nonsurgical application of principles, methods and procedures of assessment, testing, evaluation and prediction related to speech and language and its disorders and related communication impairments for the nonmedical diagnosis, prevention, amelioration or modification of these disorders and conditions.

    What is included in the practice of speech-language pathology?

    The practice of speech-language pathology in Arizona includes:

    • Rendering or offering to render to an individual or groups of individuals who have or are suspected of having disorders of communication service in speech-language pathology including prevention, identification, evaluation, consultation, habilitation, rehabilitation, instruction and research.
    • Screening, identifying, assessing, interpreting, nonmedical diagnosing and rehabilitating disorders of speech and language.
    • Screening, identifying, assessing, interpreting, nonmedical diagnosing and rehabilitating disorders of oral-pharyngeal functions and related disorders.
    • Screening, identifying, assessing, interpreting, nonmedical diagnosing and rehabilitating cognitive and communication disorders.
    • Assessing, selecting and developing augmentative and alternative communication systems and providing training in the use of these systems and assistive listening devices.
    • Providing aural rehabilitation and related counseling services to hearing impaired persons and their families.
    • Enhancing speech-language proficiency and communication effectiveness.
    • Screening hearing and other factors for speech-language evaluation and initially identifying persons with other communication disorders and making the appropriate referral.

    What is specifically excluded from the practice?

    N/A

    Are there any certifications required for specific practices?

    N/A

    Reference

    A.R.S. § 36-1901


  • Arizona Occupational Therapy Scope of Practice

    14 Oct 2021 3:46 PM | Zachary Edgar (Administrator)

    How is occupational therapy defined in Arizona?

    "Occupational therapy" means the use of therapeutic activities or modalities to promote engagement in activities with individuals who are limited by physical or cognitive injury or illness, psychosocial dysfunction, developmental or learning disabilities, sensory processing or modulation deficits or the aging process in order to achieve optimum functional performance, maximize independence, prevent disability and maintain health. Occupational therapy includes evaluation, treatment and consultation based on the client's temporal, spiritual and cultural values and needs.

    What is included in the practice of occupational therapy?

    Occupational therapy services in Arizona includes the following:

    • Developing an intervention and training plan that is based on the occupational therapist's evaluation of the client's occupational history and experiences, including the client's daily living activities, development, activity demands, values and needs.
    • Evaluating and facilitating developmental, perceptual-motor, communication, neuromuscular and sensory processing function, psychosocial skills and systemic functioning, including wound, lymphatic and cardiac functioning.
    • Enhancing functional achievement, prevocational skills and work capabilities through the use of therapeutic activities and modalities that are based on anatomy, physiology and kinesiology, growth and development, disabilities, technology and analysis of human behavioral and occupational performance.
    • Evaluating, designing, fabricating and training the individual in the use of selective orthotics, prosthetics, adaptive devices, assistive technology and durable medical equipment as appropriate.
    • Administering and interpreting standardized and nonstandardized tests that are performed within the practice of occupational therapy, including manual muscle, sensory processing, range of motion, cognition, developmental and psychosocial tests.
    • Assessing and adapting environments for individuals with disabilities or who are at risk for dysfunction.

    What is specifically excluded from the practice?

    N/A

    Are there any special trainings or requirements?

    N/A

    Reference

    A.R.S. § 32-3401

  • Arizona Physical Therapy Scope of Practice

    14 Oct 2021 3:44 PM | Zachary Edgar (Administrator)

    How is the practice of physical therapy defined in Arizona?

    Examining, evaluating and testing persons who have mechanical, physiological and developmental impairments, functional limitations and disabilities or other health and movement related conditions in order to determine a diagnosis, a prognosis and a plan of therapeutic intervention and to assess the ongoing effects of intervention.

    What is included in the practice of physical therapy?

    Alleviating impairments and functional limitations by managing, designing, implementing and modifying therapeutic interventions including:

    • Therapeutic exercise.
    • Functional training in self-care and in home, community or work reintegration.
    • Manual therapy techniques.
    • Therapeutic massage.
    • Assistive and adaptive orthotic, prosthetic, protective and supportive devices and equipment.
    • Pulmonary hygiene.
    • Debridement and wound care.
    • Physical agents or modalities.
    • Mechanical and electrotherapeutic modalities.
    • Patient related instruction.

    Reducing the risk of injury, impairments, functional limitations and disability by means that include promoting and maintaining a person's fitness, health and quality of life.

    Engaging in administration, consultation, education and research.

    Services specifically excluded from the scope of practice

    N/A

    Are there any special trainings required?

    Arizona PT Dry Needling

    Reference

    A.R.S. § 32-2001

  • California Speech Therapy Scope of Practice

    1 Oct 2021 4:56 PM | Zachary Edgar (Administrator)

    How does California define the practice of speech-language pathology?

    The practice of speech-language pathology means all of the following:

    • The application of principles, methods, instrumental procedures, and non-instrumental procedures for measurement, testing, screening, evaluation, identification, prediction, and counseling related to the development and disorders of speech, voice, language, or swallowing.
    • The application of principles and methods for preventing, planning, directing, conducting, and supervising programs for habilitating, rehabilitating, ameliorating, managing, or modifying disorders of speech, voice, language, or swallowing in individuals or groups of individuals.
    • Conducting hearing screenings.
    • Performing suctioning in connection with the scope of practice, after compliance with a medical facility’s training protocols on suctioning procedures.

    Any observation of an abnormality shall be referred to a physician and surgeon.

    What is specifically excluded from the practice?

    N/A

    Flexible Fiber Optic Nasendoscopic Procedure

    A licensed speech-language pathologist shall not perform a flexible fiber optic nasendoscopic procedure unless he or she has received written verification from an otolaryngologist certified by the American Board of Otolaryngology that the speech-language pathologist has performed a minimum of twenty-five (25) flexible fiber optic nasendoscopic procedures and is competent to perform these procedures. The speech-language pathologist shall have this written verification on file and readily available for inspection upon request by the board.

    A speech-language pathologist shall pass a flexible fiber optic nasendoscopic instrument only under the direct authorization of an otolaryngologist certified by the American Board of Otolaryngology and the supervision of a physician and surgeon.

    A licensed speech-language pathologist shall only perform flexible endoscopic procedures in a setting that requires the facility to have protocols for emergency medical backup procedures, including a physician and surgeon or other appropriate medical professionals being readily available.

    Reference

    Cal. Bus. and Prof. Code § 2530.2

  • California Occupational Therapy Scope of Practice

    1 Oct 2021 4:53 PM | Zachary Edgar (Administrator)

    How is occupational therapy defined in California?

    “Occupational therapy” means the therapeutic use of purposeful and meaningful goal-directed activities (occupations) with individuals, groups, populations, or organizations, to support participation, performance, and function in roles and situations in home, school, workplace, community, and other settings.

    Occupational therapy services are provided for habilitation, rehabilitation, and the promotion of health and wellness for clients with disability- and nondisability-related needs or to those who have, or are at risk of developing, health conditions that limit activity or cause participation restrictions. Occupational therapy services encompass occupational therapy assessment, treatment, education, and consultation.

    Occupational therapy addresses the physical, cognitive, psychosocial, sensory-perception and other aspects of performance in a variety of contexts and environments to support engagement in occupations that affect physical and mental health, well-being, and quality of life.

    What is included in the practice of occupational therapy?

    Occupational therapy techniques that are used for treatment involve:

    • Teaching activities of daily living (excluding speech-language skills);
    • Designing or fabricating orthotic devices, and applying or training in the use of assistive technology or orthotic and prosthetic devices (excluding gait training).

    Occupational therapy consultation provides expert advice to enhance function and quality of life. Consultation or treatment may involve modification of tasks or environments to allow an individual to achieve maximum independence. Services are provided individually, in groups, or populations.

    Occupational therapy treatment is focused on developing, improving, or restoring functional daily living skills, compensating for and preventing dysfunction, or minimizing disability. Through engagement in everyday activities, occupational therapy promotes mental health by supporting occupational performance in people with, or at risk of experiencing, a range of physical and mental health disorders.

    What is specifically excluded from the practice?

    N/A

    Are there any special trainings or requirements?

    California OT Hand Therapy

    California OT Physical Agent Modalities

    California OT Topical Medications

    California OT Swallowing Assessment, Evaluation and Training

    Reference

    Cal. Bus. and Prof. Code § 2570.2

  • California Physical Therapy Scope of Practice

    1 Oct 2021 4:52 PM | Zachary Edgar (Administrator)

    How is physical therapy defined in California?

    Physical therapy means the art and science of physical or corrective rehabilitation or of physical or corrective treatment of any bodily or mental condition of any person by the use of the physical, chemical, and other properties of heat, light, water, electricity, sound, massage, and active, passive, and resistive exercise, and shall include physical therapy evaluation, treatment planning, instruction and consultative services.

    What is included in the practice of physical therapy?

    The practice of physical therapy includes the promotion and maintenance of physical fitness to enhance the bodily movement related health and wellness of individuals through the use of physical therapy interventions.

    What is specifically excluded from the practice?

    The use of roentgen rays and radioactive materials, for diagnostic and therapeutic purposes, and the use of electricity for surgical purposes, including cauterization, are not authorized under the term “physical therapy”, and a physical therapy license does not authorize the diagnosis of disease.

    Are there any special trainings required?

    See Electromyography

    See Topical Medications

    Board Statements on the Scope of Practice

    Can PTs practice wound debridement?

    Debridement is performed by the use of sharp instruments including, but not limited to, scalpel, scissors, forceps or tweezers. Debridement of devitalized tissue is not to be confused with surgical debridement, which is to be performed by a physician and includes the removal of both devitalized and vitalized tissues. Physical therapists by education and training should be able to differentiate between necrotic, nonviable tissue, and viable tissues.

    It is the official position of the Physical Therapy Board of California that, with appropriate training, physical therapists can perform debridement of nonviable tissue. Furthermore, it is the position of the Board that physical therapists may utilize sharp instruments such as scalpels, scissors, forceps, tweezers and other appropriate instruments to perform debridement.

    Does California allow PTs to remove staples and sutures?

    The removal of staples is a non-invasive procedure, which would ordinarily come under the heading of nursing services and is not normally associated with the practice of physical therapy; however, physical therapists may provide any non-invasive physical rehabilitation procedure they have been adequately trained to perform. Should a facility elect to train physical therapists to do staple removal, the facility would need a written protocol to be included in their policies and procedures manual, and to be used in the training of each physical therapist who will perform this procedure.

    The training protocol must be sufficient to ensure the facility's patients that the procedure is being done in a safe and efficient manner by personnel who are trained specifically to remove staples. The training should also include procedures for problem situations resulting from staple removal, and for notification of proper medical personnel.

    The removal of sutures would fall under the same category as the removal of staples as indicated above.

    Reference

    Cal. Bus. and Prof. Code §2620

    California Physical Therapy Board Position Statements

  • Overhaul of our Medicare Appeals Section

    31 Aug 2021 1:52 PM | Zachary Edgar (Administrator)

    Medicare Appeals

    Denials by Medicare are on the rise.  Congress and the Office of Inspector General have both called for increased scrutiny over Part A and B Medicare claims.  Reduced payments to Medicare Advantage Plans have caused the plans to take a more hardline approach to claims approvals and denials.  Providers’ main tool to combat these denials is the appeals process.   If you are thinking about filing an appeal and need assistance, please contact us at zedgar@med-comply.com.

    Levels of Appeals and Time Limits for Filing

    Good Cause for Late Filing

    Decisions Subject to Appeal

    Who may File an Appeal Representatives

    Appointing the Representative 

    Reopenings

    Level 1: Redetermination Level 2: Reconsideration Level 3: Administrative Law Judge (ALJ) Hearing

    Level 4: Appeals Council Review

    Level 5: Judicial Review


  • Texas Physical Therapy FAQs

    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


About Me

Zachary Edgar JD, LLM is the managing partner for Therapy Comply.  Zachary is a healthcare attorney that specializes in federal and state healthcare regulatory issues particularly for physical, occupational, and speech therapy practices.  

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