88. Occupational And Physical Therapy

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88. Occupational And Physical Therapy

 

 

CATEGORY:Alternative Medicines 300 Courses

COURSE NUMBER: 88

FEES: 555/- INR only

CERTIFICATE VALIDITY: Lifetime

CERTIFICATES DELIVERY: In 48 hours

BOOKS/ MANUALS: Pages

Syllabus

Preface ………………………………………………………………………………………………………………………. 5
Certification and Ongoing Responsibilities …………………………………………………………………………….. 7
Other Facilities …………………………………………………………………………………………………………. 7
Responsibilities …………………………………………………………………………………………………………. 8
Supervision Requirements ………………………………………………………………………………………….. 9
Declaration of Supervision ……………………………………………………………………………………… 9
Supervision Waiver ………………………………………………………………………………………………. 9
Durable Medical Equipment and Disposable Medical Supplies ………………………………………………. 9
Provider Communication ……………………………………………………………………………………………….. 11
Coordination with School-Based Services Providers …………………………………………………………. 11
Coordination with County Birth to 3 Programs ……………………………………………………………….. 11
Therapy Services for Children Brochure……………………………………………………………………….. 11
Guide to Obtaining Augmentative Communication Devices and Accessories …………………………. 12
Directory of Used Medical Equipment ………………………………………………………………………….. 12
Documentation Requirements ………………………………………………………………………………………… 13
Prescriptions ………………………………………………………………………………………………………….. 13
Evaluations ……………………………………………………………………………………………………………. 13
Plan of Care ………………………………………………………………………………………………………….. 13
Daily Entries ………………………………………………………………………………………………………….. 14
Services and Requirements ……………………………………………………………………………………………. 15
Initial Spell of Illness ………………………………………………………………………………………………… 15
Daily Limitations ……………………………………………………………………………………………………… 15
Duplicate Services…………………………………………………………………………………………………… 16
Evaluations ……………………………………………………………………………………………………………. 16
Group Therapy ……………………………………………………………………………………………………… 16
Natural Environments ……………………………………………………………………………………………… 16
Durable Medical Equipment and Disposable Medical Supplies …………………………………………….. 17
HealthCheck “Other Services” ……………………………………………………………………………………. 17
Services Not Separately Reimbursable…………………………………………………………………………. 17
Reimbursement Not Available ……………………………………………………………………………………. 17
Codes ………………………………………………………………………………………………………………………. 19
Procedure Codes ……………………………………………………………………………………………………. 19
Unit of Service ………………………………………………………………………………………………….. 19
Modifiers ………………………………………………………………………………………………………………. 19
Place of Service Codes…………………………………………………………………………………………….. 19
Diagnosis Codes …………………………………………………………………………………………………….. 19
Prior Authorization ……………………………………………………………………………………………………….. 21
Prior Authorization Forms and Attachments ………………………………………………………………….. 21
PHC 1384

Medical Necessity …………………………………………………………………………………………………… 21
Relationship of Medical Necessity to Clinical Practice Principles ………………………………………. 22
Flexibility of Approved Services ………………………………………………………………………………….. 23
Plan of Care Must Reflect Flexibility of Approved Services …………………………………………… 23
Duration of Approved Services ……………………………………………………………………………… 23
Coordinating Multiple Prior Authorization Requests ……………………………………………………… 23
Requesting Extension of Therapy, Maintenance Therapy, and Services That Always Require Prior
Authorization …………………………………………………………………………………………………………. 25
Approval Criteria …………………………………………………………………………………………………….. 25
Extension of Therapy ……………………………………………………………………………………………… 26
Maintenance Therapy ……………………………………………………………………………………………… 26
Direct Maintenance ……………………………………………………………………………………………. 26
Monitoring Maintenance ………………………………………………………………………………………. 27
Discontinuing Maintenance …………………………………………………………………………………… 27
Services That Always Require Prior Authorization……………………………………………………………. 28
Cotreatment …………………………………………………………………………………………………….. 28
Dual Treatment ………………………………………………………………………………………………… 29
Unlisted Procedure Codes ……………………………………………………………………………………. 29
Decubitus Ulcers ……………………………………………………………………………………………….. 29
Requesting Spell of Illness……………………………………………………………………………………………… 31
Maximum Allowable Treatment Days ………………………………………………………………………….. 32
Unused Treatment Days …………………………………………………………………………………….. 32
Extension of Therapy vs. Spell of Illness ………………………………………………………………………….. 33
Requesting Services for Birth to 3 Participants……………………………………………………………………. 35
Situations That Do Not Qualify for Birth to 3…………………………………………………………………. 36
Requesting Amendments ……………………………………………………………………………………………… 37
Approval Criteria …………………………………………………………………………………………………….. 37
Reasons for Denial………………………………………………………………………………………………….. 37
Claims ………………………………………………………………………………………………………………………. 39
837 Health Care Claim: Professional ……………………………………………………………………………. 39
CMS 1500 …………………………………………………………………………………………………………….. 39
Provider Numbers …………………………………………………………………………………………………… 39
Individual Providers ……………………………………………………………………………………………. 39
Groups, Clinics, and Nursing Homes……………………………………………………………………….. 39
Rehabilitation Agencies ………………………………………………………………………………………… 40
Hospitals ………………………………………………………………………………………………………….. 40
Referring Provider …………………………………………………………………………………………………… 40
Evaluations ……………………………………………………………………………………………………………. 40
Services Provided Beyond Daily Limits …………………………………………………………………………. 40
Unlisted Procedure Codes…………………………………………………………………………………………. 40
Multiple Services During One Session…………………………………………………………………………… 41
Submitting Claims for Birth to 3 Services ……………………………………………………………………… 41

Reimbursement ………………………………………………………………………………………………………….. 43
Maximum Allowable Fees …………………………………………………………………………………………. 43
Reimbursement Methods …………………………………………………………………………………………. 43
Natural Environment Enhanced Reimbursement ……………………………………………………….. 43
Copayment …………………………………………………………………………………………………………… 43
Annual Copayment Maximum ………………………………………………………………………………. 44
Appendix …………………………………………………………………………………………………………………… 45
1. Certification Requirements and Reimbursement Information for Physical Therapy,
Occupational Therapy, and Speech and Language Pathology Providers ………………………………. 47
2. Allowable Services and Supervision Requirements for Assistants, Students, and Aides ……………. 51
3. Declaration of Supervision for Nonbilling Providers Instructions ………………………………………….. 53
4. Declaration of Supervision for Nonbilling Providers Form (for photocopying) …………………………. 57
5. Request for Waiver of Physical Therapist Assistant and Occupational Therapy Assistant
Supervision Requirements Form (for photocopying) ……………………………………………………….. 59
6. Medicaid Therapy Services for Children ……………………………………………………………………….. 61
7. A Guide to Obtaining Augmentative Communication Devices and Accessories Through
Wisconsin Medicaid …………………………………………………………………………………………………. 73
8. Allowable Procedure Codes for Physical Therapy Services ………………………………………………… 81
9. Allowable Procedure Codes for Occupational Therapy Services………………………………………….. 85
10. Allowable Procedure Codes for Speech and Language Pathology Services ……………………………. 87
11. Allowable Physical Therapy Procedure Codes for Birth to 3 Services …………………………………… 91
12. Allowable Occupational Therapy Procedure Codes for Birth to 3 Services …………………………….. 93
13. Allowable Speech and Language Pathology Procedure Codes for Birth to 3 Services ………………. 95
14. Allowable Modifiers for Physical Therapy, Occupational Therapy, and Speech and Language
Pathology Services………………………………………………………………………………………………….. 97
15. Allowable Place of Service Codes for Physical Therapy, Occupational Therapy, and Speech
and Language Pathology Services ………………………………………………………………………………. 99
16. Examples of Standards of Medical Necessity As Evaluated on Prior Authorization Requests …… 101
17. General Principles for Physical Therapy, Occupational Therapy, and Speech and Language
Pathology Prior Authorization Requests………………………………………………………………………. 107
18. Extension of Therapy vs. Spell of Illness ……………………………………………………………………. 109
19. Allowable ICD-9-CM Codes for Physical Therapy Spell of Illness Approval
(Organized by Codes)……………………………………………………………………………………………. 111
20. Allowable ICD-9-CM Codes for Physical Therapy Spell of Illness Approval
(Organized by Statements) …………………………………………………………………………………….. 115
21. Allowable ICD-9-CM Codes for Occupational Therapy Spell of Illness Approval
(Organized by Codes)……………………………………………………………………………………………. 121
22. Allowable ICD-9-CM Codes for Occupational Therapy Spell of Illness Approval
(Organized by Statements) …………………………………………………………………………………….. 125
23. Allowable ICD-9-CM Codes for Speech and Language Pathology Spell of Illness Approval
(Organized by Codes)……………………………………………………………………………………………. 131
24. Allowable ICD-9-CM Codes for Speech and Language Pathology Spell of Illness Approval
(Organized by Statements) …………………………………………………………………………………….. 135
25. Prior Authorization Request Form (PA/RF) Completion Instructions for Physical Therapy,
Occupational Therapy, and Speech and Language Pathology Services ……………………………… 139
26. Sample Prior Authorization Request Form (PA/RF) for Physical Therapy Services ………………… 143
27. Sample Prior Authorization Request Form (PA/RF) for Occupational Therapy Services ………….. 145

28. Sample Prior Authorization Request Form (PA/RF) for Speech and Language Pathology
Services ……………………………………………………………………………………………………………… 147
29. Prior Authorization/Therapy Attachment (PA/TA) Completion Instructions …………………………. 149
30. Prior Authorization/Therapy Attachment (PA/TA) (for photocopying) ……………………………….. 159
31. Prior Authorization/Spell of Illness Attachment (PA/SOIA) Completion Instructions ………………. 165
32. Prior Authorization/Spell of Illness Attachment (PA/SOIA) (for photocopying)……………………… 169
33. Prior Authorization/Birth to 3 Therapy Attachment (PA/B3) (for photocopying) …………………… 173
34. CMS 1500 Claim Form Instructions for Physical Therapy, Occupational Therapy, and Speech
and Language Pathology Services …………………………………………………………………………….. 175
35. Sample CMS 1500 Claim Form for Physical Therapy Services………………………………………….. 181
36. Sample CMS 1500 Claim Form for Occupational Therapy Services …………………………………… 183
37. Sample CMS 1500 Claim Form for Speech and Language Pathology Services……………………… 185
38. General Information About the Birth to 3 Program ……………………………………………………….. 187
39. Procedures to Follow When the Birth to 3 Agency Pays the Commercial Health
Insurance Liability …………………………………………………………………………………………………. 189
Index ……………………………………………………………………………………………………………………… 191

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