With stagnant or decreasing reimbursement and rising expenses, more practices are considering going out-of-network (OON) with some insurers. However, what information must owners consider when making this decision? In this article (Part 1 of 3), I will answer the following questions:

If you are on social media, whether Facebook, LinkedIn, X (formerly Twitter), I am sure you are seeing posts of therapists in private practices complaining about the difference in reimbursement hospital outpatient therapy departments receive compared to a private practice when providing the exact same intervention(s) and/or procedure(s). However, instead of complaining, I think private practices should use this discrepancy to their advantage. In this article, I will answer the following questions and provide valuable insight how private practices can use this discrepancy to increase their business and revenue.

In the private practice setting, the Centers for Medicare and Medicaid Services (CMS) requires that the physical therapist (PT) provide direct supervision of the physical therapist assistant (PTA) and that the occupational therapist (OT) provide direct supervision of the occupational therapy assistant (OTA) when the PTA and OTA are furnishing covered services to a Medicare beneficiary receiving outpatient physical or occupational therapy services, respectively. This means the supervising PT or OT must be present in the office suite at the time the service(s) is provided by the PTA or OTA to the Medicare beneficiary. What providers want to know is

This article was updated on July 23, 2020 due to Secretary Azar extending the Public Health Emergency due to the COVID-19 pandemic. This article was updated on June 23, 2020 due to CMS clarifying if a practitioner can be out of the country and provide a telehealth visit to a Medicare beneficiary in a state where the practitioner is licensed in. See below for the question and the answer. This article was updated on May 27, 2020 due to the Centers for Medicare and Medicaid Services expanding telehealth coverage for outpatient therapy services to include institutional providers. Please see questions

The Merit-Based Incentive Payment System (MIPS) in 2019 will now include physical therapists, occupational therapists and speech-language pathologists that treat Medicare beneficiaries in the private practice setting. The simplest way to know if you are a private practice under the Medicare program is that you submit claims to your Medicare Administrative Contractor on a 1500-claim form. Over the next several weeks, I will be answering question I receive on the MIPS program to help you get prepared. In addition, I will be presenting a 2.5 hour MIPS webinar on December 18, 2018 from 1:00pm – 3:30pm ET. For additional information