I had the senior therapy consultant for our FI read the section 230.2 on
OT. She was surprised by what she read and said that the therapists that
review the charts are not that archaic. It was interesting to learn that
our FI has a LMRP (Local Medical Review Policy) for Physical Therapy and
not for Occupational Therapy or Speech Therapy.
After a lengthy discussion with this senior therapy consultant, I learned
that our billing office needs to go to the remarks field from Medicare to
find out what was the reason for the denial. The information provided is
very specific. So now I don't have to struggle with "usage guidelines not
met".
It was a great educational session and I fell our billing office learned
something as well.
Dudi Wittwer, O.T.R.
Manager, Rehab Services
Bay Area Hospital
1775 Thompson Road
Coos Bay, Oregon 97420
[EMAIL PROTECTED]
(541) 269-8003
Ron Carson
<[EMAIL PROTECTED]
om> To
Sent by: "[EMAIL PROTECTED]"
[EMAIL PROTECTED] <[email protected]>
now.com cc
Subject
07/12/2005 03:46 Re: [OTlist] Medicare Benefit
PM Policy 230.2 Practice of
Occupational Therapy
Please respond to
[email protected]
Dang, this is a pretty good explanation of how I've seen many, many OT's
practice over the years! SAD, but true!
If you disagree with something that in your fiscal intermediary's
documents, call them. They may change it. I had a problem where my
intermediary didn't cover OT evaluations in ALF. I called them, they
reviewed my suggestions and made corrections. It was very simple and
surprisingly effective. Of course, this is a CMS issue but your FI may
be able to help!
Let us know how it turns out!
Ron
----- Original Message -----
From: [EMAIL PROTECTED] <[EMAIL PROTECTED]>
Sent: Tuesday, July 12, 2005
To: [email protected] <[email protected]>
Subj: [OTlist] Medicare Benefit Policy 230.2 Practice of Occupational
Therapy
dbo> I am in the process of trying to determine why the FI denied services
for
dbo> OT, PT & Speech. The comment was "usage guidelines not met". So I
went to
dbo> the most recent CMS Pub 100-02 Medicare Benefit Policy Transmittal 34.
dbo> This transmittal is effective June 6, 2005.
dbo> I was totally surprised to read the examples regarding the practice of
dbo> Occupational Therapy:
dbo> The selection and teaching of task-oriented therapeutic activities
dbo> designed to restore physical function; e.g. use of woodworking
dbo> activities on an inclined table to restore shoulder, elbow and
wrist
dbo> range of motion lost as a result of burns;
dbo> Teaching a patient with a hip fracture/hip replacement techniques
of
dbo> standing tolerance and balance to enable the patient to perform
such
dbo> functional activities as dressing and homemaking tasks.
dbo> Then it went on to state that a qualified occupational therapist is
defined
dbo> as "eligible for the National Registration Examination of the American
dbo> Occupational Therapy Association".
dbo> Several questions came to mind after reading this and sharing this
dbo> information with a fellow OT. How old is the definition of our
services
dbo> use by Medicare? Do the FI's really base their decision on these
dbo> descriptors? Am I the only one who thinks these examples are out
dated and
dbo> the eligible for exam is incorrect?
dbo> Dudi Wittwer, O.T.R.
dbo> Manager, Rehab Services
dbo> Bay Area Hospital
dbo> 1775 Thompson Road
dbo> Coos Bay, Oregon 97420
dbo> [EMAIL PROTECTED]
dbo> (541) 269-8003
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