Medicare Compliance & Reimbursement

New qualification standards should help facilities get paid.

Even though the National Association of Athletic Trainers continues to fight the new requirements in court, the Centers for Medicare and Medicaid Services recently implemented its revisions governing the qualifications of those who provide physical and occupational therapy as "incident-to" a physician's services.

In short, these revisions prohibit physicians from billing Medicare and other payers for physical therapy services unless a professionally educated PT provides them. A PT assistant may also provide the services as long as a PT provides direct supervision.

Remember: The PT doesn't have to be licensed for you to bill the service incident-to a physician.

NATA contends such a decision improperly restricts athletics trainers' ability to practice. This summer, the association challenged the incident-to changes by filing a lawsuit in the United States District Court for the Northern District of Texas.

In July, the court dismissed the case, and CMS immediately implemented the new rules. NATA has since appealed the North District's ruling.

Under the old incident-to policy, physicians could bill Medicare for incident-to physical therapy services that non-physical therapy providers--such as athletics trainers, licensed physical therapy assistants, massage therapists and recreation therapists--performed.

Result: This meant that insurers were paying for services provided by unqualified therapists.