PT: Issues related to Reimbursement &Regulation

Consumer information: Employment, Disability, Insurance
Sponsored by the Arthritis Foundation, but the info has broad relevance to any disabling condition.

• Talking to Your Employer
• Laws that Can Help on the Job
• Workplace Accommodations
• Changing Jobs
• Work Disability
• Health Insurance
• Disability Insurance
• Government Plans: Social Security Disability Insurance (SSDI), and Supplemental Security Income (SSI)

Centers for Medicare and Medicaid Services (CMS)
US Dept. Health and Human Services

1. "Medicare and You" (2009)
is the pamphlet that is mailed to all beneficiaries each year. It is in lay language and easy to follow.
There's no need to print this, just use it as a reference to look up certain information.
Read: "What you will pay..." on p.120 (Part A) and p.121 (Part B)
There is a Glossary of terms on p.115-118.

2. Program of All-Inclusive Care for the Elderly (PACE)

3. Centers for Medicare and Medicaid Service (CMS):
Hospital comparisons
Nursing Home comparisons
Home Health Agency comparisons

4. CMS: Fall Risk Assessment is mandated for the elderly, along with a financial incentive to the PT. This is part of a quality reporting initiative begun in 2007.

1. Analysis by the APTA:
   APTA. (2009). Physician Quality Reporting Initiative Measure Specifications Manual for Claims and Registry. Retrieved 10-22-2009. http://www.apta.org/AM/Template.cfm?Section=Home&TEMPLATE=/CM/ContentDisplay.cfm&CONTENTID=53540
2. Reporting forms:
   American Academy of Neurology. (2009). Falls: Risk Assessment (Measure 154) and Plan of Care (Measure 155). Retrieved 10-22-2009. http://www.aan.com/globals/axon/assets/4973.pdf

5. Medicaid

• Medicaid - a primer (Kaiser Family Foundation)
• MO HealthNet for Kids
• Medical Services -MO HealthNet

Eligibility_Criteria_Documentation

6. APTA - Reimbursement
Some links are passworded for members only. Has a useful glossary.

7. APTA - Defensible Documentation for Patient/Client Managment: "Documentation of a Visit/Encounter"

8. FIM: Terminology for Level of Assistance for Functional Skills

9. Discharge Planning

10. Part A: SNF & post-acute Rehab: admission

11. Part A: Home Health: admission and homebound status

12. SNF: Medicare coverage

13. Rehab Service Documentation

14. Part A: Hospice Admission Criteria

15. Adult Day Connection: eligibility criteria

16. Medicare B: coverage of Therapeutic Footwear for people with diabetes

17. DME: Medicare coverage
Kelly DellaRocca serves in an advisory capacity to a local pharmacy on management of DME.

18. ICD-9: Index to Diseases
Volume 1: search by category
Volume 2: search alphabetically

19. Compare Health Coverage Plans from various Insurance Companies
National Committee for Quality Assurance (NCQA)

20. Physician Owned Physical Therapy Services (POPTS)

• APTA informational brochure with citations
• APTA position paper "white paper"
  
• Mitchell JM, Scott E. (1992). Physician ownership of physical therapy services. Effects on charges, utilization, profits, and service characteristics.  JAMA. 268(15):2055-9.
• APTA website: Top PT Issues in the Statehouse (members only access)
• Relevant Missouri statutes: search for Section 334.252, and Section 334.253

Missouri Division of Professional Registration - website

• Section 334.506: Direct Access     web version
• PT Continuing Education Requirements
• Supervision of PTAs