PTA being paid cash (Full Version)

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cowboybuboy -> PTA being paid cash (September 29, 2007 12:55:24 AM)

Just wanted to know if anybody here has an idea if it's okay for a PTA to go to a person's house and get paid cash?
I have a PTA who works with me in home health asking this question. Apparently, the family wanted to continue therapy even after home health is done and they're willing to pay cash.
There is an order to continue PT. But the family has no time to go to outpatient. Therefore, they asked the PTA who's working with their mother to continue and will be paying cash.
I'm in Illinois and I don't know if this is okay.
Any ideas?
Thanks!



FLAOrthoPT -> RE: PTA being paid cash (September 29, 2007 6:17:34 PM)

not sure, depends on state, i would go in as a PT and do a favor for your PTA and write up a plan of care, that way everything is legal, you can charge too for overseeing the case.   Unfortunately we can't turn our degree on and off, once you have that degree of PTA, you are always a PTA, so even if a personal trainer can do it no prob, if a PTA needs a PT plan of care, then even if it is off the books, you still need that plan of care, because they are always held to that license and state practice guidelines.  so, i do this once in a while, I do my pta a favor and oversee the case, i do an eval and sup and dc, and have the PTA pay me for my time and making it legal for them.



SJBird55 -> RE: PTA being paid cash (September 30, 2007 10:18:15 AM)

According to Medicare guidelines, Medicare would still have to be billed for services, to then create a denial for those services.  The services would need to have a GX modifier I believe AND the patient is required to sign a Medicare form (I believe an ABN) that indicates the patient realizes that Medicare may not pay for the services that will be provided.  That Medicare form does indicate that Medicare will initially be billed for services.  Technically, it wouldn't be the PTA that would be receiving payment for services, but instead the organization that is submitting the claim for services.  This is of course me making a huge assumption that 1) services are still required, hence the referral to continue PT but 2) the patient is no longer home bound.  The family paying out of pocket is a nice gesture, but it really isn't the best option for the family.

If the patient no longer meets home bound status and that is the reason for discharge from home health services, then technically, the patient can now receive outpatient physical therapy services with Medicare part B responsible for the benefits/coverage.  Outpatient services CAN be provided in the home using the appropriate identifier on the claim for location of services.  You can look for providers doing In-Home rehabilitation - Peter Kovacek would be a great contact on PTManager to assist you in meeting this patient's needs.  Make sure that the home health agency did a formalized discharge with Medicare so that when outpatient PT becomes involved it is very clear that the home health agency closed the case - otherwise, outpatient claims will be denied and the home health agency will be responsible for reimbursing the outpatient company for services provided by the outpatient company.  If you have your own NPI number then I suppose that you could provide the services and bill Medicare for the outpatient services provided in the home.  The PTA cannot submit claims to Medicare because PTAs do not have NPI.  So, if you stayed involved, you'd be responsible for submitting the claims and following outpatient physical therapy rules and regulations.  If you're following me, then I'm sure you are believing that the PTA would be providing services "incident to" you.  You can't think that way though because the PTA in an outpatient setting can only provide services with you providing supervision and you'd have to be in the building for the defined level of supervision.  Therefore.... only you, the PT, could provide outpatient services in a patient's home billing Medicare B, unless of course the patient lives in an assisted living situation and then the PTA could provide services as long as you were in the building.



ehanso -> RE: PTA being paid cash (September 30, 2007 3:02:59 PM)

Another question. Does the PTA have their own independent liability insurance? If they are practicing as in independent provider, they should have it. Additionally, they will need to file the income with the IRS and state and pay the FICA, medicare and other taxes. They should also continue with documentation for each visit. Personally, I think that it is not appropriate for them to do this without ongoing PT supervision but your state may allow it.



cowboybuboy -> RE: PTA being paid cash (September 30, 2007 10:27:45 PM)

Thanks to all who responded. I know it's not the best option to pay cash. But the family does not have time to take care of her. Thus, she's living in an assisted living facility. So, I just adviced the PTA to discontinue once the home health agency is done with the patient.



FLAOrthoPT -> RE: PTA being paid cash (October 1, 2007 7:41:00 PM)

you can go through a CORF or CRA and do it under part B and have the PTA in there alone



SJBird55 -> RE: PTA being paid cash (October 2, 2007 6:26:34 AM)

FLA... I'm not as familiar wtih CORF or CRA regulations, but wasn't there some transmittal earlier this year that was supposed to equalize the regulations between the CORF and the outpatient hospitals and the independent practices?  Documentation requirements AND supervision clauses?  If that was the case, and I honestly don't know, then the PTA still couldn't go in alone.



FLAOrthoPT -> RE: PTA being paid cash (October 2, 2007 6:13:41 PM)

no CORF and certified rehab agency allows PTAs to be in a home or anywhere for that matter without being supervised by the PT. the PT needs to write the POC and do an eval and supervision, etc, but PTA can go in the home alone.



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