Huh?

As we pierce thru the maze of methods to try and get an extra 1.5% from CMS for voluntary reporting, we find a major glitch.  It is only available if you submit your claims on a HCFA 1500 or its electronic version 837.  Which essentially makes it only available for PT’s in private practice including those working in POPTS.

Makes great sense doesn’t it?  Don’t forget though that this is from the same cast of characters that have made hospital’s exempt from a cap, an exceptions policy that can be gamed quite easily by folks who were responsible for this absurdity to begin with (SNF’s), and a whole new way of defining “group therapy” and 8 minutes.

Larry

Comments

[Selena Horner]

Supposedly the initiative is for individual providers versus an organization. Physical therapists that practice in settings in which an NPI is not necessary when submitting claims are not included in the initiative because the identifying information for the specific provider (NPI) is not provided on those claim forms.

Could have just been an error on behalf of CMS in not including all providers because inherently the people that are making decisions aren't communicating to the people that understand the processes involved. Also the lack of standardization for processes and lack of consistency across practice settings creates glitches whenever something new is incorporated.

Beats me why supervision of PTAs isn't consistent across all practice settings; beats me why Medicare A is paid differently than Medicare B; beats me why physicians have different "incident to" regulations; beats me why documentation requirements are setting specific. Actually, maybe these inconsistencies are in place to increase fines/penalties extended to providers? Just provides another option for CMS to capture additional monies after audits are performed to cover their costs of regulating all the inconsistencies?