Reimbursement and PTA supervision

Question 1

What does supervision of a PTA look like in hospitals or other clinical settings?

Answer 1

1. Require constant onsite supervision
2. A joint treatment with the PT and PTA or a direct treatment by the PT with a conference between the PT and PTA must occur at least ONCE PER WEEK

Question 2

What does supervision of a PTA look like in schools, home-health, and long term care?

Answer 2

1. PT must be available by communication to PTA at all times during treatment
2. Initial visit and establishment of plan of care by PT
3. Joint visit or conference with PT and PTA on or before first visit by PTA
4. At least once every 6th PTA visit or every 30 calendar days (whichever comes first) the PT needs to make a visit
5. Supervisory visit must include: functional onsite assessment, review of activities with appropriate modifications or termination of plan of care (with documentation), and assessment of utilization of outside resources

Question 3

how long just minors’ medical records be kept?

Answer 3

until the child reaches 21 years plus the states statute of limitations
- statute of limitations - medicare requires 5 years, but most states keep 10 years

Question 4

What are potential exclusions of related services that won’t be covered?

Answer 4

1. sub malleolar orthotics
2. maintenance therapy
3. fitness equipment
4. bikes, bathroom equipment
5. wellness
   and more…

Question 5

DME usually has an annual max dollar amount set. What are potential examples that could be covered?

Answer 5

1. orthotics
2. wheelchairs
3. TLSO’s
   and more of those things..

Question 6

Is maintenance therapy covered?

Answer 6

depends; some policies will allow for X visits for HEP instruction with maintenance care

Question 7

What are the 5 questions you must answer while writing functional goals?

Answer 7

1. Who
2. Will do what
3. Under what condition
4. How Well
5. By when

Question 8

What are the ABC’s of goal writing?

Answer 8

Audience
Behavior
Condition
Degree
Emphasize 
Function

Question 9

What are reasons for denial?

Answer 9

1. Expiration of the policy
2. Exhaustion of the benefit
3. Noncovered/Exclusionary Service
4. Not Medically Necessary
5. Lifetime Cap; Consideration during Plan of Care; Opportunity to access additional funding sources
6. No referral - if medicaid

Question 10

Who funds medicaid programs

Answer 10

both federal and state government

Question 11

True or false: PT is a federally mandated Medicaid service.

Answer 11

False

• it is not; a state can choose to allow as few as 0 PT visits for a Medicaid policy
• for children though, it IS a federally mandated service

Question 12

Who is eligible for medicaid?

Answer 12

eligibility is determined by:

1. Income
2. disability
3. if they are a child
   - eligibility parameters are determined state by state

Question 13

If a child has Medicaid as a secondary insurance is it billed 1st or 2nd?

Answer 13

2nd

- medicaid is a payer of last resort

Question 14

If a child has Medicaid as a secondary insurance will the patient be responsible for any portion of their payment?

Answer 14

No, their visit will be completely paid for unless the state determines they will not cover physical therapy as a mandated service, the treatment, or DME is deemed not medically necessary

Question 15

Models of _____ ______ allow for integration of knowledge, research, and assumptions in a clinically relevant fashion that ultimately leads to evidence-based decision making

Answer 15

service delivery

- team approach: Multi vs. trans/primary service provider

Question 16

Individual discipline-specific assessments of a specific developmental area; Discipline-specific treatments; Discipline-specific goals and objectives

Answer 16

Multidisciplinary

• Disadvantages:
  1. Least effective
  2. Fragmented care
  3. Poor communication between team members
  4. Lost opportunities in other developmental areas
  5. Lots of providers in the home
  6. Not Family Friendly

Question 17

Team discipline specific assessments; Cooperative treatments; however each team member continues to be primarily responsible for their area of expertise; Discipline specific goals and objective with input and awareness from all team members

Answer 17

Interdisciplinary

• Advantages:
  1. Improved communication
  2. Awareness for other disciplines
  3. Elimination of lost opportunities
  4. Continue to have lots of expertise
• Disadvantages:
  1. Lots of providers
  2. Borderline family friendly

Question 18

Development is viewed as an integrated process; Generally team discipline specific evaluation; Cooperative goal writing and treatment plan development among all team members (including families); Primary service provider - Main person providing early intervention services who is typically chosen based on child’s greatest area of need, and should regularly be re-evaluated and possibly changed; NOT intended to be a cost-saving method

Answer 18

Transdisciplinary/ primary service provider

• Research supports this model as the ideal model for learning in infants and young children (birth-3)
• Advantages:
  1. Family friendly
  2. Eliminates lost opportunities
• Disadvantages:
  1. Most difficult to accurately incorporate
  2. Often times used as a cost savings method or in cases of therapist shortages
  3. Difficult for parents and professionals to understand
  4. Requires lots of regular communication
  5. Not easy for new graduates (requires lots of mentorship)
  6. Some need for role release
  7. Watch for scope of practice issues

Question 19

What settings can PTAs practice without onsite supervision?

Answer 19

1. schools
2. home health
3. SNFs
   - PT must be available by communication at all times during tx

Question 20

Can PTAs perform gentle handling to promote alertness and state control to prepare for bottling with the RN with a 2 week old infant in the NICU?

Answer 20

No. PTAs can’t work in the NICU because of the rapid examination and changing status of babies

• NICU is not a place for entry level PTs
• PTAs cannot work in ICUs either due to unstable patient