Hello Elizabeth: You are probably right that with enough 'elbow grease' BC/BS will pay for OT. Perhaps a better way for me to phrase my comment is: It is BC/BS of Florida's policy to NOT directly reimburse OT as preferred providers. I know that BC/BS WILL pay for OT but only as OUT OF NETWORK providers. According to what they told me, there are NO in-network OT providers.
In order to make my first post less 'techie', I left out some important lingo. As I understand Medicare, they do not pay based on discipline but on procedure code. ALL CPT codes are designed to be discipline independent. In other words, anyone who can legally perform self-care training can bill the procedure code of 97535. As far as medicare's concerned, it doesn't matter which discipline does the procedure because they are not a policing agency for scope of practice. It is my feeling that Medicare assumes that if someone bill's for a procedure, then they are qualified to have done that procedure. ======================================================= On Monday, February 2, 2004, @ 7:26 PM, you wrote: ET> Actually Ron, you can't be a preferred provider under BC/BS of FL. They do ET> pay for rehabilitative OT for 25 visits a year or something like that. They ET> actually will pay, you just have to fight them tooth and nail for it. If I ET> would have stayed in private practice, I would have fought this more. Some ET> of my clients families (children) have fought BC/BS successfully for some OT ET> benefits for their childrne. ET> I would also complain about the Medicare representative because, obiviously, ET> she has no idea what she is talking about. You can get your own Medicare ET> number as an OT and bill separately. ET> Elizabeth H. Thiers, OTR/L ET> FECTS ET> [EMAIL PROTECTED] ET> -----Original Message----- ET> From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf ET> Of Ron Carson ET> Sent: Monday, February 02, 2004 10:00 AM ET> To: [EMAIL PROTECTED] ET> Subject: [OTnow] Lack of Parity ET> As an OT in private-practice, I come across interesting situations involving ET> insurance. Most situations, are less than encouraging and today is no ET> exception. ET> First, I learned that an OT Evaluation is not billable under my provider ET> type at an Assisted Living Facility. However, a PT evaluation is billable ET> under my provider type. ET> In trying to understand the reasoning behind this disparity, I was told by a ET> Medicare Representative that OT is viewed as a type or subset of PT. She ET> then went on to tell me that as fare as medicare was concerned, that I ET> could bill for a PT evaluation whenever I do an evaluation at an assisted ET> living facility. ET> Secondly, Blue Cross/Blue Shield of Florida does not contract with OT. ET> Between OT, PT and SLP, they only contract with PT. What this means is that ET> as an OT, I can not be a participating provider with BCBS. I can be a ET> non-participating provider but this has reduced benefits for the client. ET> BCBS says that most (all) OT referrals are made by PT's working at ET> facilities. Whenever,a PT sees a client who they think needs OT they then ET> make a referral to OT. The facility then pays the OT, either as an employee ET> or a sub-contractor. ET> A friend of mine told me that they would never be an OT because we are ET> treated as 'second class citizens'. It's times like this I tend to agree. ET> Ron ET> _______________________________________________ ET> To unsubscribe, visit: ET> http://otnow.com/mailman/listinfo/otlist_otnow.com ET> The OTnow Mail Archive: ET> www.mail-archive.com/[EMAIL PROTECTED] ET> =============================================== _______________________________________________ To unsubscribe, visit: http://otnow.com/mailman/listinfo/otlist_otnow.com The OTnow Mail Archive: www.mail-archive.com/[EMAIL PROTECTED] ===============================================
