Yesterday, I saw one of my 'snowbirds'. She is 79 years old and she spends the summer in Maine and the winter in Florida (I live in Florida).
She came in to see me in January and had rehab on her rotator cuff. Now, she is back because she fell on the golf course and injured her knee.
Her orthopedic surgeon saw her after the fall gave her a cortisone shot and four visits to therapy.
The surgeon didn't give her more therapy in case she needed surgery.
He explained didn't want to 'use up' her therapy by hitting the Medicare cap. He felt she would need more therapy after surgery.
The cap is a spending limit that Medicare applies to every beneficiary. This year the cap limits the beneficiary to $1,810 in billed physical therapy.
Typical physical therapy billed charges use up the cap in 16-20 visits.
Patients are coming to me now who have used up their benefit in July, or May or whenever.
What the surgeon didn't know (or didn't tell) was that the physical therapist can apply for an exception in special circumstances.
The exception is based on three simple things:
- Patient need
- Patient progress
- Physical therapist decision-making
With all due respect, most surgeons should just stick to surgery.
Physical therapists in outpatient, non-hospital clinics can examine their patients, case-by-case, to see if the patient has characteristics that would qualify for the exception.
The fact that this surgeon was the owner of one of the largest non-hospital physical therapy clinics in the state of Florida and a direct competitor of mine may have had something to do with his 'interpretation'.
I don't know.