Three weeks ago, I wrote an article “One-on-One: Does It Only Apply to Medicare“. Of all the articles I have written and posted since Gawenda Seminars started in 2004, this one received the most blog posts, most email questions, and even in one case, a Gawenda Gold Member waking up at night in a full blown sweat wondering if they had done something wrong all these years.
Why did they have a nightmare because of that article? It all had to do with the term “qualified healthcare professional” and using therapist as an example of a qualified healthcare therapist. That has led to me receiving many questions regarding the use of support personnel (i.e. rehab aide, rehab tech, athletic trainer, etc) and is the time they spend treating a patient billable time to an insurance carrier. In this article, I will define support personnel, further define qualified healthcare professional and finally answer the question “Is the time a support personnel (i.e. rehab aide, rehab tech, etc.) is treating a patient billable time to the insurance carrier”?
We must remember that the American Medical Association (AMA) is the organization that creates and maintains the CPT codes. Under “Therapeutic Procedures”, it states “physician or other qualified health care professional (ie, therapist), required to have direct (one-on-one) patient contact. The AMA does not mention a therapist assistant, therapy assistant, athletic trainer, rehab aide, rehab tech, etc., as an example of a qualified healthcare professional. Does this mean they can’t provide therapy services? Does this mean we, physical and occupational therapists, are not allowed to use these individuals to provide therapy services under our supervision and direction?
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What do I have to do to get on and view this article or register. I still haven’t had the time to view much.
You would need to become a Gold Member. Becoming a Gold Member gives you access to all the content on the website as well as email updates. It does not incldue webinars. To join, go to http://gawendaseminars.com/subscription/
Hope this helps you!
I had a question about Tricare as a secondary insurance. If Medicare is the primary, and they pay for services rendered by a PTA, but Tricare is secondary, and they don’t pay for services rendered by a PTA, can we still have the PTA treat that patient since Medicare is primary? We are a hospital based Outpatient Rehab Thank you for your time!
Tricare does not pay for services provided by assistants in the private practice setting. This does not apply to institutional settings such as hospitals.
In your reply to the question above, you stated “Tricare does not pay for services provided by assistants in the private practice setting. This does not apply to institutional settings such as hospitals.” Rehab Agencies follow rules as institutional setting, correct?
TRICARE does not pay for services provided by a physical therapist assistant in any setting.
What changed between May 2016 “Tricare does not pay for services provided by assistants in the private practice setting. This does not apply to institutional settings such as hospitals.” and February 2017 “TRICARE does not pay for services provided by a physical therapist assistant in any setting.”?
Watch for my article that will be released on Monday about TriCare and the use of assistants.
This question is regarding the billing of technician time with insurances that are Medicare “look alikes”…like a cigna Senior plan or many of the advantage plans…they say they follow medicare guidelines….can time with techs be billable for these insurances or would we apply the Medicare rules related to technicians to these insurance plans as well?
Thank you in advance.
Difficult for me to answer. If the insurance carrier is stating they follow Medicare rules and regulations, one could imply that would also include the use of PT techs. If that is the case, services provided by a PT tech would not be considered skilled therapy and not billable to the insurance carrier.
Any Recommendations on documenting for tech/aide time? Plan- PT to be provided by PT, PTA, supervised tech.
Daily note: supervised tech assistance?
I would recommend you check your state practice act.
in illinois; ok to use aides, no particular guidance on documenting. thanks rick
Rick in VA we are allowed to use aides/techs under direct supervision. In regards to Tricare Chapter 11 section 10.1. says a provider can use aide or tech under direct supervision. Is a physical therapist considered a provider for Tricare? Does this chapter apply to physical therapy?
Please read my article on who can provide services to TriCare patients. http://gawendaseminars.com/2017/current-news-posts/tricare-and-use-of-assistants/
A few years after the fact….
What if Medicare is SECONDARY and BCBS is PRIMARY? Should PT aide/tech time be billed? – It is allowed with BCBS.
Any suggestions would be greatly appreciated.
If you are submitting to the Medicare program at all, PT techs/aides time can’t be billed.
How does this work in relation to the one-on-one rule? Can a PT have two people on their schedule at the same time, and bill for one-on-one time if one patient is with the PT and one patient is with an aide? Can two 1 unit ther ex charges then be made for the same 15 min, for example? My employer is wanting us to start doing this, so I would really like to know where is the documentation to support that this is, or is not, allowed.
Please read this article: https://gawendaseminars.com/double-booking-non-medicare-patients-how-do-i-bill/
Also, you can search on my website for articles. In the search box, type in the words “double book”.
I read the article regarding double booking Medicare patients as well as the on regarding non-Medicare patients and think I understand those concepts. What about double booking one Medicare and one non-Medicare patient together and utilizing a tech or aide to assist with only the non-Medicare patient (assuming that it is allowed per state practice act as well as with the non-Medicare insurance)?
Hi Ken! That article is coming out on Monday, September 27, 2021.