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03/19/20

California Mandates Payment for Telehealth

Effective immediately, all health plans in the state of California shall comply with the following: Health plans shall reimburse providers at the same rate, whether a service isprovided in-person or through telehealth, if the service is the same regardless ofthe modality of delivery, as determined by the provider’s description of theservice on the claim. For example, if a health plan reimburses a mental healthprovider $100 for a 50-minute therapy session conducted in-person, the healthplan shall reimburse the provider $100 for a 50-minute therapy session done viatelehealth. For services provided via telehealth, a health plan may not subject enrollees tocost-sharing greater

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03/19/20

Kentucky Shuts Down All Outpatient Rehabilitative Settings

Effective March 19, 2020, all outpatient rehabilitative settings shall close and transition to a telehealth platform in accordance with DMS guidance immediately. Click HERE to read it straight from the Governor. Skilled rehabilitation professionals (physical therapists, occupational therapists, speech languagetherapists, and respiratory therapists) shall continue to work in acute care, inpatient rehabilitativesettings, and skilled nursing facilities. Their work will allow patients to heal sooner and return home to their preferred setting. All CDC recommended protective measures shall be in place when providing services to patients. Home health rehabilitation professionals shall use best clinical judgment to determine best practicefor the implementation

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03/16/20

TRICARE Releases Final Rule Regarding Assistants

TRICARE has finally issued the long awaited final rule to add physical therapist assistants (PTAs) and occupational therapy assistants (OTAs) as TRICARE authorized providers to provide physical therapy or occupational therapy services under the supervision of a TRICARE-authorized physical therapist (PT) or occupational therapist (OT) in accordance with Medicare’s rules for supervision and qualification. TRICARE will implement I hope you enjoyed this article and this great news that has long been overdo. Thank you for being a Gold Member!

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02/24/20

Humana Resumes Prior Authorization for Outpatient Therapy

On December 18, 2017, Humana announced they would no longer require preauthorization for outpatient physical, speech and occupational therapy services for patients with commercial and Medicare Advantage (MA) coverage. Unfortunately, nothing lasts forever. Effective with dates of service on and after I hope you found this article helpful and informative. Thank you for being a Gold Member!

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06/10/19

Can New PT and PTA Graduates Treat Medicare Patients

A question I often receive is can a new graduate physical therapist or graduate physical therapist assistant treat Medicare patients while they are waiting to take their national examination and have their services supervised by a licensed physical therapist (PT) or physical therapist assistant (PTA) and billed to the Medicare program? Does the Centers for Medicare and Medicaid Services (CMS) answer this question and if yes, where is the answer? In this article, when I mention Medicare, I am referring to traditional Medicare and not Medicare Advantage plans. Yes, CMS does answer this question and the answer can be found

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05/14/18

Can I Treat Patient’s in Their Home as an Outpatient

Whether an insurance carrier will pay for therapy services provided in the patient’s home under their outpatient therapy benefits is the answer most people do not like; it is insurance carrier specific. Regarding the Medicare program, the Centers for Medicare and Medicaid Services (CMS) states therapy services are payable under the Medicare Physician Fee Schedule when furnished by a provider or supplier in the following settings:

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