Tricare and TriWest: Are They the Same?

Last week, I wrote an article discussing Tricare and their policy regarding physical therapist assistants and occupational therapy assistants treating their beneficiaries. This is a must read article if you treat Tricare beneficiaries, whether the insurance is primary or secondary. After publication of this article, I received many emails asking if TriWest is the same…

TriCare and Use of Assistants

I receive many questions regarding TriCare and do they reimburse for services provided by a physical therapist assistant or an occupational therapy assistant? Perhaps, we should be asking if TriCare knowingly reimburses for services provided by a physical therapist assistant or an occupational therapy assistant? According to the American Physical Therapy Association as well as…

Maintenance Therapy Update

On February 2, 2017, a federal judge ruling has ordered the Secretary of Health & Human Services to carry out a Corrective Action Plan to remedy the Department’s noncompliance with the Jimmo vs Sebelius Settlement agreement concerning the coverage and payment for maintenance therapy under the Medicare program. Per the Center for Medicare Advocacy, the…

New Evaluation Codes and Percentages

In calendar year 2017, the Centers for Medicare and Medicaid Services (CMS) decided to pay the 3 physical therapy evaluation codes the exact same amount and the 3 occupational therapy evaluation codes the exact same amount. The Health Care Professional Advisory Committee (HCPAC) recommended different work relative value units (RVUs) and practice expense RVUs for…