Years ago, I graduated from the University of Florida Physical Therapy Program with a Bachelors Degree in Health Science. I was trained in orthopedics and neurology. I was not trained in Medicare.
To get information from Medicare, in 1992, you had to do the following:
- call on the telephone
- ask your question
- wait while the bureaucrat looked up your answer in the Medicare Manuals
- gave you their interpretation
- implement your policy change
Fast forward to 2008 when, if you have a question about Medicare, you can open your handy electronic copy of Transmittal 88 using the Adobe Acrobat Reader (available for free) and plug in your question to the search bar.
Curious about Medical Necessity for Physical Therapy?
What exactly do the regs say?
A quick search (<5 seconds) returns 10 instances of 'Medical Necessity' in Transmittal 88. That should get you started.
But my original premise is that many physical therapists think the Medicare Manuals are written by bureaucrats without the patients' best interests at heart.
Why should physical therapists pay attention to policy written by bureaucrats (other than the police powers exercised by Medicare)?
Pay attention to this post by Larry Benz,PT posted at the Yahoo Groups PT Manager listserve
"The medicare superimposed rules have been written by beaurocrats (sic) and our profession has acquiesced or have had "small victories" that have been alluded to that only refine them.
At the end of the day, these additional "standards" cause increased monitoring costs and take away time from patients.
If the over regulated medicare rules become de facto as is being pursued by multiple folks within the PT world, there will not be a viable outpatient PT economic model."
The obvious answer is that bureaucrats don't write Medicare regulations in a vacuum.
Medicare consults with physical therapists like Rick Gawenda, President of the APTA Section on Administration and Steve Levine of the Rehabilitation Consulting and Resource Institute to implement changes to there Manual system.
The three 'bottom line' criteria that define a compliant Medicare plan of care are these:
1) Can the physical therapist demonstrate the medical necessity for physical therapy?
2) Can the physical therapist (or the PTA) demonstrate skilled therapy for each billed procedure?
3) Can the physical therapist show an expectation of a significant improvement in measurable patient function n a reasonable time frame?
If you do good PT the first time then there are no 'increased monitoring costs'.
Good PT begins with Physical Therapy Diagnosis, just like the physicians do it.