Arnie is a 74 year old bookkeeper, living with his wife Betty in a trailer in Florida.
He lives on a fixed income - social security and some retirement income. He gets his health care from Medicare.
He has no pension since he lost his good job in the recession of 1990 and he has had to work odd jobs for the past 15 years.
Now, Arnie is weak in the legs and his balance is bad.
He fell down six times in two weeks in August and asked his doctor for a referral to physical therapy.
Physical therapy has a falls prevention program of strengthening, balance, flexibility and falls awareness training that has been shown to help seniors prevent falls and increase mobility.
But then, Arnie fell on a rain-slick driveway at night and landed on his shoulder - he ended up tearing his rotator cuff.
Arnie had used up 12 of his physical therapy visits and Medicare only allowed him about four more visits.
In America today, there are many people like Arnie - denied their Medicare physical therapy even though they clearly need help.
Today is October 25th, 2008 and every Medicare beneficiary in America has about $1,810 in physical therapy benefits for the entire year.
Unfortunately, by now many have used some or all of their benefits and could face a difficult and painful recovery if Medicare wont pay for extra physical therapy.
Fortunately, there is a solution.
Many therapists (and doctors) are unaware (or afraid) to use this solution.
The Exceptions Process
The $1,810 physical therapy Medicare cap has an exceptions process based on need and expected patient progress.
If I can show that Arnie needs extra therapy (he does) and that I can expect to get his shoulder better and prevent future falls, then he can have his extra therapy.
Therein lies the rub.
How to make the case for Arnie?
The need is easy.
Arnie is a train wreck, poor guy.
I measure his strength, flexibility and range-of-motion, as well as activity limitations using standardized test scores.
Future expected benefit is the hard part.
Many physical therapists don't know how to show expected future benefit from physical therapy.
You need to show a positive trend in your standardized test scores.
You should then graph your trend line to provide an easy visual reference for anybody who questions your decision or audits your chart.
Create a graph template that you can fill in with one, two or three months worth of test scores.
When you connect the dots the trend line should be going up - this indicates progress.
Download this free template at www.BulletproofPT.com.
Remember to modify the template to fit the needs of your physical therapy facility.
