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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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Site Updates

  • ICD-10 Codes for Therapy Services

    17 Apr 2023 2:29 PM | Zachary Edgar (Administrator)

    Added ICD-10 Codes for Medicare Therapy Services

    See Medicare ICD-10 to access the code lists.

  • New Section: Outpatient Rehabilitation Facilities

    14 Apr 2023 2:02 PM | Zachary Edgar (Administrator)

    Outpatient Rehabilitation Facilities

    Guidance on Medicare's regulation and billing procedures for outpatient rehabilitation facilities.   Members have full access to the material below and can contact us with any questions regarding Medicare compliance and billing issues. 


  • No Q2 Changes to Therapy NCCI Codes

    26 Mar 2023 10:52 AM | Zachary Edgar (Administrator)

    CMS is not releasing NCCI updates for the second quarter of 2023.   Updates that apply to physical, occupational, and speech therapy services will be posted as they change.

    See our NCCI page for the current PTP and MCU Edits.

    https://www.cms.gov/medicare-medicaid-coordination/national-correct-coding-initiative-ncci/ncci-medicare/medicare-ncci-procedure-procedure-ptp-edits

  • Updated Florida Occupational Therapy FAQs

    22 Mar 2023 2:41 PM | Zachary Edgar (Administrator)

    Definitions

    Occupational Therapy Practice

    • Scope of Practice
    • Referrals - Direct Access
    • Telehealth
    • Documentation
    • Consumer Information

    Supervision and Delegation

    • OT Responsibilities
    • Assistants
    • Aides
    • Students and New Graduates

    Conduct

    • Ethical Conduct
    • Unethical Conduct 
    • Fee Splitting

    Board Statements and Forms

    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

    License Issues

    • Initial License
    • Temporary License
    • Reciprocity
    • Out-of-State Therapists 
    • Inactive or Retired Status


  • Florida Physical Therapy FAQs have been Updated

    22 Mar 2023 12:12 PM | Zachary Edgar (Administrator)

    Florida Physical Therapy

  • New Section Therapists in Private Practice

    28 Feb 2023 10:40 AM | Zachary Edgar (Administrator)

    Medicare guidelines and requirements for therapists in private practice.

    https://therapycomply.com/Medicare/Private-Practice/


  • New section Medicare Certification and Recertification of the POC

    20 Feb 2023 12:33 PM | Zachary Edgar (Administrator)

    Certification and Recertification of the Plan of Care

    Members have full access to the guides below and can contact us with questions regarding and Medicare documentation or billing issue, consider joining today if you need assistance. 

    Certification of the POC

    • What does it mean to have the POC certified?
    • Is a referral or order required under Medicare?
    • What methods of certification are allowed?

    When does the POC need to be Certified? 

    • When is certification consider to be "timely"?
    • What happens if the certification cannot be obtained on time?

    Recertification of the POC

    • When does the POC need to be recertified?
    • Is a recertification the same as a reevaluation?
    • Does Medicare require the patient to visit the physician/NPP before recertification? 

    Who can Certify the POC?

    • Which practitioners are allowed to certify a POC?
    • Which practitioners are not allowed to certify a POC?
    • What does "under the care of the physician" mean?

    Problems Obtaining Certification

    • What should I do if the physician/NPP does not respond to request for signature? 

    Denials Due to Certification Issues

    • Can a denial based on certification be appealed?
    • Examples of when certification issues cause denials

  • Updated Texas Physical Therapy FAQs

    16 Feb 2023 12:28 PM | Zachary Edgar (Administrator)

    See our Texas Physical Therapy FAQs for the updates effective March 1, 2023

  • New Section HIPAA Cybersecurity

    9 Feb 2023 3:52 PM | Zachary Edgar (Administrator)

    We have added a new section to the website to help members better understand the cybersecurity best practices for HIPAA compliance. 

    HIPAA Cybersecurity 

    Webinar: HIPAA for Physical and Occupational Therapists

    March 1st at 12:00 PM CST

    March 2nd at 12:00 PM EST


  • Medicare Progress Report FAQs

    8 Feb 2023 10:50 AM | Zachary Edgar (Administrator)

    See our Medicare Progress Report section for more guidance.

    Who must complete the progress report?

    Information required in progress reports shall be written by a clinician that is, either the physician/NPP who provides or supervises the services, or by the therapist who provides the services and supervises an assistant.

    Who must sign the report?

    The clinician who completed the report must sign and date report.

    It is not required that the referring or supervising physician/NPP sign the progress reports written by a PT, OT or SLP.

    When does the progress report need to be completed?

    The minimum progress report period shall be at least once every ten (10) treatment days. The day beginning the first reporting period is the first day of the episode of treatment regardless of whether the service provided on that day is an evaluation, reevaluation or treatment.

    The next treatment day begins the next reporting period. The progress report period requirements are complete when both the elements of the progress report and the clinician’s active participation in treatment have been documented.

    What happens if the report is delayed?

    If the clinician has not written a progress report before the end of the progress reporting period, it shall be written within 7 calendar days after the end of the reporting period. If the clinician did not participate actively in treatment during the progress report period, documentation of the delayed active participation shall be entered in the treatment note as soon as possible. The treatment note shall explain the reason for the clinician’s missed active participation. Also, the treatment note shall document the clinician’s guidance to the assistant or qualified personnel to justify that the skills of a therapist were required during the reporting period. It is not necessary to include in this treatment note any information already recorded in prior treatment notes or progress reports.

    References

    Medicare Benefit Policy Manual Ch. 15 – Covered Medical and Other Health Services § 220.3

    Billing and Coding: Outpatient Physical and Occupational Therapy Services: A57067


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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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