WorksheetsMedicare Myth Bash
Total questions: 10
Worksheet time: 8mins
When a clinician modifies short-term goals (STGs) the treatment plan must be re-certified by the physician.
FACT: If the changes to the STGs or interventions are a result of normal progression in the patient’s condition or adjustments to the plan are due to lack of expected response, these changes are considered insignificant alterations and do not require a physician signature to indicate certification.
FACT: Any time a clinician modifies a goal, regardless of how the goal is modified, the treatment plan must be re-certified by the physician.
Billing for Group Therapy is not allowed for Part B patients.
FACT: Medicare does allow Part B patients to receive skilled therapy services in a group setting. Definitions for what constitutes a group differ based on payer source.
FACT: Medicare places a 25% limit on group therapy per discipline.
FACT: Medicare does not allow group treatment for part B services. Only those services delivered as individual minutes are allowed to be counted.
Therapeutic exercise when performed under the supervision of a therapist always constitutes skilled therapy.
FACT: If the therapeutic exercises require the therapist’s skill for instruction, cueing and safety or if the patient’s medical condition is so complex that the treatment can only safely and effectively be performed by a therapist, then the services would be covered. However, routine exercises that can be carried out by non-skilled personnel would not be considered covered services.
FACT: Treatment is considered skilled when a licensed therapist or therapist assistant provides the service. If therapeutic exercises is supervised by a licensed clinician it is always considered skilled.
When performing group therapy all patients do not have to be the same payer source.
FACT: The patients in the group are not required to be of the same payer source.
FACT: The patients in the group are required to be of the same payor source.
FACT: The patients in the group can consist only of two payor sources.
Evaluations are always billed as 15 minutes
FACT: The number of minutes billed for an evaluation should be solely based on the time it takes to complete a thorough evaluation. You need to take as much time as is clinically indicated to perform the evaluation and this will vary based on the individual needs and medical complexity of your patient.
FACT: Evaluations should always be limited to 15 minutes of billable time because Medicare Part A does not pay for evaluations.
FACT: Evaluations must be billed for a minimum of 60 minutes in order to meet LCD guidelines.
Co-treatment is covered if 2 people are needed to physically support the patient.
FACT: Co-treatment by different disciplines may be appropriate when coordination between the two disciplines will benefit the patient, not simply for scheduling convenience or physical support. During co-treatment each therapist is doing a different treatment, and specific goals from each discipline’s plan of care must be addressed with documentation that indicates the reason for the co-treatment.
FACT: Co-treatment should be used when it is beneficial for the therapist or the therapist requires assistance with a patient to perform a complex task.
A therapy student can provide treatment under Part B as long as the supervising therapist has direct line-of-sight supervision.
FACT: Only the services of the therapist can be billed and paid under Medicare Part B. The services performed by a student are not reimbursed even if provided under “line of sight” supervision of the therapist; however, the presence of the student “in the room” does not make the service unbillable.
FACT: Medicare guidelines state that students can provide treatment under Part B only if the supervising therapist has direct line-of sight supervision.
For Medicare Part A, therapy provided on the day of discharge does count and any minutes provided can be counted on the MDS.
FACT: The discharge day is not reimbursed under PPS, however the therapy minutes on the day of discharge can be recorded on the MDS. The MDS is required to record the “total” number of minutes and does not separate out the minutes on the day of discharge. So, if therapy was provided, it should be billed.
FACT: The discharge day is reimbursed under PPS and all treatment minutes delivered on the day of discharge can be recorded as well as the treatment day. The MDS is required to record the “total” number of minutes and does not separate out the minutes on the day of discharge.
FACT: The discharge day is not reimbursed under PPS thus treatment minutes would not be recorded on the MDS assessment.
Speech-Language Pathology (SLP) services alone cannot “skill” a patient.
FACT: There are no Medicare regulations that indicate that SLP services are insufficient in order to “skill” the patient. Coverage for SNF Part A is met when all the coverage guidelines are met.
FACT: You must have at least two disciplines providing skilled treatment 5 days per week in order to "skill" a patient under Medicare Part A.
It would be appropriate for ST and PT to provide a co-treatment.
FACT: There are clinically appropriate opportunities for SLPs and PTs to co-treat; many neurologic patients can benefit from postural treatments that can assist with speech. Another example of a valid co-treatment would be when the SLP is addressing cognitive goals for sequencing as part of a speech-language pathology (SLP) treatment session while the physical therapist (PT) is training the patient to improve balance to increase independence with mobility.
FACT: It would not be appropriate for ST and PT to provide a co-treatment given each discipline's scope of practice. Co-treatment should be limited to PT and OT skilled treatments only.
