Physical Therapist Vacation Coverage Options?
There are 2 primary options that exist for a private practice physical therapy clinic to hire an outside physical therapist to treat Medicare beneficiaries while another physical therapist is on vacation, maternity leave, or any other extended episodes.
- Option 1 – Hire a licensed physical therapist and reassign that therapist’s Medicare benefits to your private practice.
- Option 2 – Determine if your physical therapy clinic may qualify under the CMS locum tenens guidelines 2022.
Option 1 – Reassignment of Benefits
The easiest option to cover a physical therapist’s leave of absence or vacation time is to hire a replacement therapist and reassign that therapist’s benefits to your business.
Reassignment of benefits is free to do and may be done in less than 20-minutes using the Medicare PECOS system.
5-Step Process to Reassign Benefits
Step 1: Ask the newly hired physical therapist for their personal NPI.
Step 2: Create a connection using that NPI between your private practice and the covering physical therapist.
Step 3: Log into your personal PECOS account then click on My Associates and scroll down to your business’s enrollments. Click on Enrollments and click View/Manage Reassignments.
Step 4: At the bottom right of the next screen you should see an option to Manage Reassignments. Clicking this link will allow you to create a new reassignment.
Step 5: Enter the therapists information including social security number and date of birth. The reassignment will process and be approved.
Note: A private practice physical therapy clinic may allow a hired physical therapist to start treating patients while the reassignment application is being processed.
Option 2 – Determine if CMS Locum Tenens Guidelines 2022 Apply
Where is Locum Tenens Available?
Health Professional Shortage Area (HPSA)
“A Health Professional Shortage Area (HPSA) is a geographic area, population group, or health care facility that has been designated by the Health Resources and Services Administration (HRSA) as having a shortage of health professionals.” (link)
There are three categories of HPSAs:
- Primary Care
- Dental Health
- Mental Health
Medically Underserved Area (MUA)
“MUAs and MUPs identify geographic areas and populations with a lack of access to primary care services. These designations help establish health maintenance organizations or community health centers.”
Rural Area
Click to see a list of Rural Health Clinics
Additional Resources:
Medicare Guidelines for Billing Therapeutic Exercise 97110 PT, OT in 2020
“Many therapeutic exercises may require the unique skills of a therapist to evaluate the patient’s abilities, design the program, and instruct the patient or caregiver in safe completion of the special technique. However, after the teaching has been successfully completed, repetition of the exercise, and monitoring for the completion of the task, in the absence of additional skilled care, is non-covered. For example, as part of the initial therapy program following total knee arthroplasty (TKA), a patient may start a session on the exercise bike to begin gentle range of motion activity. Initially the patient requires skilled progression in the program from pedal-rocks, building to full revolutions, perhaps assessing and varying the
seat height and resistance along the way. Once the patient is able to safely exercise on the bike, no longer requiring frequent assessment and progression, even if set up is required, the bike now becomes an “independent” program and is no longer covered by Medicare.”
How To Create A Telehealth Claim For Physical Therapy, OT or SLP United Healthcare
Telehealth is a hot topic for physical therapy, occupational therapy, and speech therapy due to the COVID19 virus. As insurance payers continue to increase access to telehealth services and telerehabilitation, it is important for clinicians to know how exactly to submit claims for telehealth reimbursement.
How to submit a telehealth claim for Anthem BCBS for PT OT SLP in 2020
Learning how to create a submit a telehealth claim for physical therapy, occupational therapy, and speech therapy can be an important skillset right now during the global pandemic and social distancing. In this video I show you what Anthem BCBS of Georgia is requiring you do to create a CMS 1500 claim for telehealth services.
