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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

  • New Recorded Webinars for Yearly Members

    5 Feb 2022 4:27 PM | Zachary Edgar (Administrator)

    Recorded Webinars for Yearly Members 

    Yearly members can access all recently recorded webinars here.  CE credit is available for many of these courses, please contact Zachary at zedgar@med-comply.com.  


  • Changes to the Medicare Documentation Section

    31 Jan 2022 2:48 PM | Zachary Edgar (Administrator)

    Documentation for Therapy Services

    Therapy Comply's Medicare documentation guides for physical, occupational, and speech therapy.  

    Sample Audit Form - Can be used to audit outpatient therapy documentation. 

    General Documentation Requirements

    • Document Requirements
    • The Patient is under the Care of a Physician/NPP
    • Services Require the Skills of a Therapist
    • Services are of Appropriate Type, Frequency, Intensity and Duration 
    • Needs of the Patient
    • Dictated Documentation
    • Dates for Documentation

    Evaluations

    • When it is Appropriate for an Initial Evaluation
    • Contents of an Evaluation
    • When the Evaluation is the Only Service Provided
    • When the Evaluation Serves as the Plan of Care
    • Additional Assessments
    • Evaluations by Multiple Disciplines

    Plan of Care

    • Establishing the Plan of Care
    • Elements of the Plan of Care
    • Modifying the Plan of Care

    Certification and Re-certification of the Treatment Plan

    • What does it mean to have the plan of care certified?
    • Do I need an order/prescription/referral from a physician/NPP?
    • When does the POC need to be certified?
    • Is the initial treatment date when I began treating the patient or when I performed the evaluation?
    • How long do certifications last?
    • What happens if I can’t get the plan certified within ninety (90) days?
    • Do I need to submit additional evidence to justify the delay?
    • Who must certify the POC?
    • Which practitioners are not allowed to certify a plan of care?
    • Can I have the physician/NPP sign a document other than the POC?
    • Are verbal certifications acceptable?
    • When does the POC need to be recertified?
    • What happens if the recertification is delayed?
    • What happens if my claim is denied due to certification issues?

    Progress Reports 

    • Timing of the Progress Report
    • Content of the Progress Report
    • Therapist’s Participation in the Report
    • Assistant’s Participation in the Report

    Treatment Notes

    • Required Elements
    • Optional Elements
    • Examples for Specific Services
    • Making Changes to the Note
    • Signature on the Note
    • Identification of the Supervisor

    Reevaluations

    • Who may Perform a Reevaluation?
    • Role of the Assistant
    • When can a Reevaluation be Performed?
    • Reimbursement
    • Content of the Reevaluation
    • Billing for a Reevaluation
    • Documentation

    Discharge Summary

    • What is Required in the Discharge Note?
    • Unanticipated Discharge
    • Optional Information

      Medicare Signature Requirements

      • Which outpatient therapy documentation requires and signature and who must sign?
      • What is required for a valid signature?
      • What if I use a scribe when documenting medical record entries?
      • How are orders treated differently than other medical documentation?
      • What should I do if I did not sign an order or medical record?
      • What if I signed the order or progress note but my signature is not legible?
      • What is a signature log?
      • What if I do not have a signature log in place?
      • Am I able to attest to my signature?
      • Do my signatures need to be dated?


    • North Carolina Medicaid Guidelines

      28 Jan 2022 3:23 PM | Zachary Edgar (Administrator)

      North Carolina Medicaid Outpatient Therapy 

      Guidelines for North Carolina's Medicaid coverage of physical, occupational and speech therapy services.  Including coverage, limitations, prescription requirements, prior authorization and documentation.  If the client is enrolled in a managed care plan some of the rules may be different.  If you need additional assistance please email us at info@therapycomply.com.

      Eligible Providers

      • Eligible Providers
      • Settings
      • Assistants

      Documentation 

      • Documentation Requirements
      • Evaluations
      • Re-evaluations
      • Treatment Plan
      • Discharge
      • Follow-Up

      Medical Necessity for SLP Services

      • Oral Phase, Pharyngeal Phase, or Oropharyngeal Phase Dysphagia
      • English Language Proficiency
      • Language Impairment Classifications Infant/Toddler: Medicaid Beneficiary Birth to 3 Years:
      • Language Impairment Classifications: Medicaid Beneficiary 3 – 5 Years of Age
      • Language Impairment Classifications: Medicaid Beneficiary 5 through 20 Years of Age and NCHC Beneficiary 6 through 18 Years of Age
      • Articulation/Phonology Impairment Classifications : Medicaid Beneficiary birth through 20 Years of Age and NCHC Beneficiaries 6 through 18 Years of Age
      • Articulation Treatment Goals Based on Age of Acquisition
      • Phonology Treatment Goals Based on Age of Acquisition of Phonological Rules
      • Eligibility Guidelines for Stuttering
      • Differential Diagnosis for Stuttering
      • Augmentative and Alternative Communication (AAC) Devices
      • Audiology Therapy (Aural Rehabilitation)
      • Evaluation for Central Auditory Processing Disorders (CAPD)

      Prescription Requirement

      • Who may order therapy services?
      • When does the order need to be signed?
      • How long are verbal/written orders valid for?

      Prior Approval

      • Beneficiaries under the Age of 21 Years
      • Visit Limitations Beneficiaries 21 Years of Age and Older
      • Medical Necessity Visit Guidelines for Beneficiaries Under 21 Years of Age

      Treatment 

      • Medical Necessity
      • Co-Treatment


    • California Medicaid Outpatient Therapy Guidelines

      28 Jan 2022 10:17 AM | Zachary Edgar (Administrator)

      Guidelines for California's Medicaid coverage of physical, occupational and speech therapy services.  Including coverage, limitations, prescription requirements, prior authorization and documentation.  If the client is enrolled in a managed care plan some of the rules may be different.  If you need additional assistance please email us at info@therapycomply.com.

      Physical Therapy

      • Eligible Providers
      • Prescription Requirements
      • Covered Services
      • Prior Authorization
      • Claim Information

      PT Codes and Rates

      Speech Therapy

      • Eligible Providers
      • Coverage
      • Written Referral Requirements
      • Initial and Six-Month Evaluations
      • Required Professional Experience Services

      SLP Codes and Rates

      Occupational Therapy

      • Eligible Providers
      • Limitations
      • Prescription Requirement
      • Initial and Six-Month Evaluations
      • Claims

      OT Codes and Rates


    • Compliance Policies and Procedures

      19 Jan 2022 11:04 AM | Zachary Edgar (Administrator)

      We have recently added a number of new sample policies and procedures that can be easily adapted to any therapy practice.

      Visit at our Compliance Page. 

    • Tricare for PT/OT/SLP

      4 Jan 2022 9:05 AM | Zachary Edgar (Administrator)

      Tricare coverage of physical, occupational, and speech therapy.

      Provider Enrollment

      • Network and Non-Network Providers
      • Participating and Non-Participating Providers

      Billing

      • Claims
      • Directly Billing the Patient
      • Appeals

      Physical Therapy

      • CPT Codes Covered
      • Description
      • Coverage Criteria
      • Services Not Covered

      Physical Therapy Assistants

      • Qualifications
      • Scope of Practice
      • Supervision
      • Reimbursement
      • CQ Modifier
      • Services Not Covered

      Specific Services

      • Biofeedback
      • NMES Devices
      • Dry Needling
      • Negative Pressure Wound Therapy

        General Rehabilitation

        • Medical Necessity
        • Covered Services
        • Maintenance Programs
        • Rehabilitative Programs
        • Services Not Covered

        Telehealth

        Occupational Therapy

        • Covered Codes
        • Description
        • Prescription
        • Services Not Covered

        Occupational Therapy Assistants

        • Qualifications
        • Scope of Practice
        • Supervision
        • Reimbursement
        • CO Modifier
        • Services Not Covered

        Speech Therapy

        • Covered CPT Codes
        • Description of Services
        • Criteria for Coverage
        • Services Not Covered

        Prosthetics and Orthotics

        • Orthoses Splints and Braces
        • Prosthetic Devices and Supplies


        • January 2022 NCCI Edits for Outpatient Facilities

          27 Dec 2021 12:49 PM | Zachary Edgar (Administrator)

          PT/OT Evaluations and Re-evaluations

          • 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

          Speech Therapy

          • Treatment of Speech; individual
          • Treatment of Speech; group
          • Laryngeal Function Studies
          • Evaluation of Speech Fluency
          • Evaluation of Speech Sound Production
          • Evaluation of Speech with Evaluation of Language Comprehension
          • Behavioral and Qualitative Analysis of Voice and Resonance
          • Treatment of Swallowing Dysfunction
          • Evaluation for Use and/or Fitting of Voice Prosthetic Device
          • Evaluation for Prescription of Speech-Generating AAC Device; first hour
          • Evaluation for Prescription of Speech-Generating AAC Device;  30 minutes
          • Therapeutic Services for Use of Speech-Generating Device
          • Evaluation of Oral and Pharyngeal Swallowing Function
          • Motion Fluoroscopic Evaluation
          • Endoscopic Swallow Evaluation (FEES)
          • Laryngeal Sensory Testing
          • Flexible Fiberoptic Endoscopic Evaluation (FEESST)
          • Assessment of Aphasia


        • January 2022 NCCI Edits for Practitioners

          27 Dec 2021 12:40 PM | Zachary Edgar (Administrator)

          PT/OT Evaluations and Re-evaluations

          • 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

          Speech Therapy

          • Treatment of Speech; individual
          • Treatment of Speech; group
          • Laryngeal Function Studies
          • Evaluation of Speech Fluency
          • Evaluation of Speech Sound Production
          • Evaluation of Speech with Evaluation of Language Comprehension
          • Behavioral and Qualitative Analysis of Voice and Resonance
          • Treatment of Swallowing Dysfunction
          • Evaluation for Use and/or Fitting of Voice Prosthetic Device
          • Evaluation for Prescription of Speech-Generating AAC Device; first hour
          • Evaluation for Prescription of Speech-Generating AAC Device;  30 minutes
          • Therapeutic Services for Use of Speech-Generating Device
          • Evaluation of Oral and Pharyngeal Swallowing Function
          • Motion Fluoroscopic Evaluation
          • Endoscopic Swallow Evaluation (FEES)
          • Laryngeal Sensory Testing
          • Flexible Fiberoptic Endoscopic Evaluation (FEESST)
          • Assessment of Aphasia


        • Webinar Recordings for Yearly Members

          14 Dec 2021 10:00 AM | Zachary Edgar (Administrator)

          We have added a new section that allows yearly members to access recorded webinars with greater ease.  Webinar Recordings for Yearly Members. 


        • Congress Passes Law to Prevent Medicare Cuts

          11 Dec 2021 10:26 AM | Zachary Edgar (Administrator)

          Congress has officially passed legislation aimed at offsetting most of a planned 3.75% cut to the conversion factor under Medicare Part B. The changes also avert across-the-board budget cuts and delay the return of the 2% "sequester" reduction next year.

          The legislation was first passed by the House of Representatives on Dec. 7, with its companion bill approved in a 59-35 bipartisan vote in the U.S. Senate on Dec. 9.

          The bill sets out three major (but temporary) relief provisions:

          • CMS will receive a 3% appropriation for 2022 to partially offset its planned 3.75% cut to the conversion factor used to set payment for codes used by providers.
          • Implementation of a looming 4% across the board "pay as you go" cut mandated through budget rules will be postponed until 2023.
          • A temporary moratorium on the 2% Medicare sequestration cut required by law since 2011 as part a deficit spending mechanism will be continued through part of 2022. The moratorium will last until April, when a 1% sequestration will return, with the full 2% sequestration reduction beginning in July. Given that sequestration cuts are baked into the Medicare system, the temporary reprieve has amounted to a small payment increase for providers since the moratorium was put in place in 2020.


        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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