Module 2: Medicare and CPT coding

Understand the goal of Payment-Driven Payment Models (PDPM) and Patient-Driven Groupings Model (PDGM) of payment and how these two payment models are similar and different

)Medicare Coding and Billing PDGM: Shift away from volume driven home health payment to model that focuses on unique characteristics, needs and goals of each ptm(This model marks the biggest home health reimbursement overhaul in two decades. PDGM shifts payment away from therapy service visit thresholds, towards patient-centered clinical characteristics. The system switches payment from a 60-day episode to 30-day periods of) 2) Medicare Coding and Billing PDMP: Shift away from volume driven SNF payment model that focuses on unique characteristics, needs and goals of each payment (major overhaul to the current skilled nursing facility (SNF) prospective payment system (PPS). It is designed to address concerns that a payment system based on the volume of services provided creates inappropriate financial incentives.)

Identify two examples of value-based payment models in the Medicare Quality Payment Program (QPP).

1) Merit based incentive payment system (MIPS) the program that will determine Medicare payment adjustments. Using a composite performance score, eligible clinicians (ECs) may receive a payment bonus, a payment penalty or no payment adjustment. MIPS features several reporting qualities not in PQRS like quality improvement activities, efforts to promote interoperability, and cost measures 2) Advanced alternative payment models (APMs) Offer participating clinicians incentive payments for improving quality and reducing care costs Address specific clinical condition, episode of care, pr pt population Advanced APMs offer participants opportunities to earn higher incentive payments for taking on additional risks based on pt outcomes measures Advanced APMs For the Medicare Quality Payment Program, know there are two different programs: MIPS and Alternative Payment Models; take a brief look at what each program entails but you will not be tested on the details of MIPS or Alternative Payment Models

Understand CPT coding requirements, including the CPT codes for physical therapy evaluation and which patient components are included in CPT evaluation coding: 97162

1-2 personal factors, 3+ elements, clinical presentation evolving

Institute of Health Care Improvement Triple Aim (From AMA Introducing health care policy and economics)

1. Population health 2. Experience of care 3. Per capita cost Most policy aim to address at least 1 of these

Differentiate regulatory features of acute hospital admissions, acute rehabilitation hospital admission, skilled nursing facility, and nursing home/long-term care (use materials provided for assigned readings, sides and preparatory work for this module. Focus on regulatory features that are important for physical therapy services Acute Rehab

3hrs/day of at least 5x/week Doctors must be available 24/7 Length of stay varies until safe to go home or transfer to LTC Any population; CVA, SCI, TBI, amputations, burns, neuro, joint replacement , Covid, congenital Eval etc... Equipment management: W/c, AD, braces, write letters of med. necessity

CPT Codes therapeutic exercises

97110

CPT codes manual therapy

97140

*3 common codes used for PT eval

97161, 97162, 97163 (low to high complexity)

Examples of CPT Codes: ¤3 eval codes indicating levels of patient severity:

97161: low-complexity 97162: moderate-complexity 97163: high-complexity

Re-evaluation CPT code

97164

CPT code therapeutic activities

97530

Differentiate what is covered under Medicare A, B and D

A- hospital, critical care, SNF, hospice, and home health. NOT LTC or custodial B- outpatient, OT/PT, some home health, NOT custodial, LTC or anything with part A D- drugs

Co insurance:

After the deductible has been met, the share of the health care bill for which the policyholder is responsible **** need a deductible to go w this

Deductible

Amount of health care bill that a pt must pay before the health insurance plan begins to contribute ****goes with co-insurance

Current Procedural Terminology (CPT) Codes

CPT coding ¤A process for reporting PT services rendered using a 5 digit coding scheme ¤Many health services are reported using CPT codes nE.g. Surgical procedures, injections ¤CPT codes are uniform and recognized across the US ¤Although CPT codes for PT services are the same across care settings, the specific interventions performed with patients will vary ¤Multiple CPT codes can be used to report one PT session

Differentiate regulatory features of acute hospital admissions, acute rehabilitation hospital admission, skilled nursing facility, and nursing home/long-term care (use materials provided for assigned readings, sides and preparatory work for this module. Focus on regulatory features that are important for physical therapy services Outpatient

Can be private px or affiliated w larger healthcare network All races, ethnicity, age, sex, medically stable Frequency and duration of therapy depends on client's dx, therapeutic needs and insurance coverage Eval, establish POC, dx, prognosis, STG/LTG

Differentiate regulatory features of acute hospital admissions, acute rehabilitation hospital admission, skilled nursing facility, and nursing home/long-term care (use materials provided for assigned readings, sides and preparatory work for this module. Focus on regulatory features that are important for physical therapy services Home Care

Care in home, focus on safety and making home environment work,usually as transition between inpatient and outpatient, require skilled needs in one discipline Any age, race, ethnicity, sex and diagnosis Some discharged directly from acute care without going to any type of inpatient rehab Must be homebound to qualify Variety diagnoses with variety of complexity Many patients seen in home care still have active medical issues as well as therapy needs Must transport all equipment in own car or mode of transportation Interprofessional team may consist of nurse, OT, SLP Much more autonomous Real life context therapy in home setting

Understand CPT coding requirements, including the CPT codes for physical therapy evaluation and which patient components are included in CPT evaluation coding: 97161

no personal factors, 1-2 elements, stable clinical presentation

Understand CPT coding requirements, including the CPT codes for physical therapy evaluation and which patient components are included in CPT evaluation coding: 97164

re-eval

Medicare A 2021 Costs Per Benefit Period: SNF admission

¤Days 1-20: $0 co-pay ¤Days 21-100: $185 coinsurance per day ¤Days 101 and beyond: all costs paid out of pocket

Medicare A 2021 Costs Per Benefit Period: Acute Care admission

¤Days 1-60: $0 co-pay ¤Days 61-90: $371 coinsurance per day ¤Days 91 and beyond: $742/day for "lifetime reserve day"

¨When delegating to anyone (PTA, Aide, etc) need to consider

¤Jurisdictional regulations (varies by state) ¤PT's experience and level of expertise ¤Delegatee's experience and training ¤Patient's condition, status, complexity ¤Risk of intervention nDon't delegate high risk interventions ¤Predictability of patient's response to intervention nDelegate interventions that have predictable responses

¨Decisions of what setting a patient should receive care in is complex and depends on such things as:

¤Medical Status ¤Therapy and continuing medical needs ¤Patient and caregiver input ¤Insurance Coverage ¨Case managers/discharge planners integrate information from the team, patient and caregivers in order to facilitate transfer to the next appropriate level of care/facility

Medicare—U.S. Federal Health Insurance: three components of medicare

¤Medicare A (Hospital Insurance) ¤Medicare B (Medical Insurance) ¤Medicare D (Prescription Drug Coverage)

Medicare—U.S. Federal Health Insurance: Who is eligible?

¤Persons 65 years or older ¤Persons who are under 65 with certain disabilities ¤People of all ages with End-Stage Renal Disease

LTAC: Patient Population

¨Adult and geriatric population ¨Every patient must require skilled nursing and at least one therapy ¨Similar diagnoses than acute rehab but client either does not need or can not tolerate 3 hours of therapy 5 days a week ¨Patients stay until "safe to go home" (with appropriate support) not until fully recovered

Outpatient: Patient Population

¨All races, ethnicity, age, sex ¨Medically stable ¨Patients typically go to provider, though telehealth is changing, result in more variable attendance to appointments ¨Frequency and duration of therapy depends on client's diagnosis, therapeutic needs, and insurance coverage

Acute Care: Patient Population

¨Any population (race, ethnicity, age, sex) ¨All demographics, some treat people who are homeless ¨Local residents or out of network ¨Length of stay (LOS): generally a few days, sometimes a few weeks

Acute Rehab: Patient Population

¨Any population (race, ethnicity, age, sex), pediatrics typically separated from adult ¨Must be able to benefit from the rehab, and participate in/tolerate 3 hours/day, 5-6 days/week ¨Typical diagnoses seen: CVA, SCI, TBI, amputations, multiple trauma, burns, other neuro (MS, Parkinson's, Guillian Barre), bilateral joint replacements, some congenital issues, COVID sequala

Medicare B

¨Anyone who is eligible for Medicare A is eligible for Medicare B ¨Usual premium is $148.50/month (some adjustments based on income) ¨Covers outpatient services (pays 80% of costs after deductible ($203 in 2021) ¤Physicians ¤Occupational Therapy ¤Speech Therapy ¤Physical Therapy ¤Durable Medical Equipment ¤Lab work, imaging, etc. ¤

Medicare B Average premium

¨Average premium is $148.50/month ¤Cost depends on your income ¤$88,000/year or less premium is $148.50/month ¤$88,001-$111,000 premium is $207.90/month ¤$111,001-$138,000 premium is $297.00/month ¤$138,001-$165,000 premium is $386.00/month ¤Above $165,000-$500,000 premium is $475.20/month

Delegation to PTA

¨Bottom line.....all PT care is ultimately the responsibility of the physical therapist ¨Keep in mind PTAs have an associates degree and are licensed ¨Part of being an efficient and effective practitioner is proper delegation of tasks and interventions and working collaboratively ¨Some practices may use other personnel such as massage therapists and athletic trainers

Outpatient Clinic

¨Can be private practice or affiliated with larger healthcare network ¨Many practices specialize in certain areas; there are "niche" practices such as women's health, spine, chronic pain to name a few ¨There are some private practices that are cash based only ¨There are some facilities that offer interdisciplinary care such as PT, OT, Speech, Massage Therapy, etc.

Medicare Requirements for Therapists in Outpatient Setting: certification forms

¨Certification form required to reimburse PT, OT or SLP services a ¨Certification forms need to be signed by the patient's MD "approving" the plan of care ¤MD must see patient within 60 days of certification ¨POC, duration and frequency, must be noted ¨Valid for up to 90 calendar days

Nursing Home LTC: Role of PT

¨Consultants only ¨Occasionally resident may receive PT services short term for acute issue or a functional decline that can be improved by PT ¨All residents receive a yearly PT screen

Medicare A 2021

¨Deductible (out of pocket cost) for each benefit period of $1,484 ¨A benefit period begins the day that you enter a hospital or SNF and ends when you have not received inpatient hospital or Medicare-covered skilled care in a SNF for 60 days in a row. ¤Days 61-90 co-insurance coverage ¤Days 90+ Life-time reserve days (60 days) ¨Medicare is not a limitless insurance; there are limits and requirements to what Medicare A will cover—next slide

Medicare D: Prescription Drug Plan

¨Drug prescription plan ¨Many different plans at many different prices ¨Participants should chose plan depending on what medications they are taking ¨Different plans cover different meds at different costs ¨Premium costs vary from $12/month to $80/Month

Medicare Reimbursement for Fee-for-Service Health Services

¨Each CPT code has an individual monetary value ¤E.g., 1 Unit of 97110 = $31.00-41.00 ¤E.g., 1 Unit of 97140 = $28.00-32.00 ¨One session of PT for a patient with Medicare Part B health insurance could be reimbursed: ¤2 units of 97110 = $62.00 ¤1 unit of 97140 = $28.00 ¤Total reimbursement = $90.00 ¨Note: reimbursement rates vary based on type of facility and regionally

Acute Rehab: Role of PT

¨Evaluate patients and establish plan of care including diagnosis, prognosis, short and long term goals, interventions, estimated length of stay and discharge plan ¨Collaborate with other team members in patient centered care and coordinate care with all team members ¨Equipment management: wheelchairs, assistive devices, braces ¤Write letters justifying needs to insurance

Outpatient: Role of PT

¨Evaluate patients and establish plan of care including diagnosis, prognosis, short and long term goals, interventions, estimated length of stay and discharge plan ¨In MA PTs have Direct access: no need for MD referral; PT must be especially skilled with diagnosing patients and identifying when need to refer ¨Patient education (home exercise program) for days they are not seeing PT ¨Justifying care to insurance companies through accurate and thorough documentation

Home Care: Role of PT

¨Evaluate patients and establish plan of care including diagnosis, prognosis, short and long term goals, interventions, estimated length of stay and discharge plan ¨PT must transport all equipment in their own car or whatever transportation they use ¨Interprofessional team may consist of nurses, OT, SLP, usually not a physician ¨PT is much more autonomous ¨Real-life context; therapy in one's home setting

School System: Role of PT

¨Evaluate patients and establish plan of care including diagnosis, prognosis, short and long term goals, interventions, estimated length of stay and discharge plan ¨The POC needs to be then written in the individualized educational plan (IEP) ¨Emphasis is on helping students access the curriculum ¨NOT to assist with ADLs or mobility outside of school setting ¨Teacher/parent education is crucial as they are part of our team

LTAC: Role of PT

¨Evaluate patients and establish plan of care including diagnosis, prognosis, short and long term goals, interventions, estimated length of stay and discharge plan. ¨Collaborate with other team members in patient centered care and coordinate care with all team members ¨Equipment management: wheelchairs, assistive devices, braces

Subacute/SNF: Role of PT

¨Evaluate patients and establish plan of care including diagnosis, prognosis, short and long term goals, interventions, estimated length of stay and discharge plan. ¨Collaborate with other team members in patient centered care and coordinate care with all team members ¨Management of equipment: assistive devices perhaps w/c

Early Intervention: Role of PT

¨Evaluate patients and establish plan of care including diagnosis, prognosis, short and long term goals, interventions, estimated length of stay and discharge plan. ¨Intervention is focused on facilitation of motor skills and family teaching ¨May complete evaluation and then supervise others such as PTAs or developmental workers in providing intervention to the child

Acute Rehabilitation Hospital

¨Every patient must get 3 hours of therapy a day, at least 5x/week (many 6-7/week) ¨Doctors must be available 24/7 in-house ¨Length of stay varies pending needs/severity of patients and payment structures ¤E.g., CVA length of stay could range from 1-3 weeks ¨If patients do not progress "quick enough" transferred to less intense setting (Long-Term Acute Care (LTAC), Skilled Nursing Facility (SNF)) ¨Patients stay until "safe to go home" (with appropriate support) not until fully recovered

Medicare Medicare coverage based on 3 main factors:

¨For all "covered" services there are certain criterion that need to be met for coverage ¨Medicare coverage based on 3 main factors ¤Federal and state laws ¤National coverage decisions made by CMS (Centers for Medicare and Medicaid Services) ¤Local coverage decisions made by the fiscal intermediary (can vary from state to state) ¨Criteria vary greatly depending on service and setting

Medicare A Premium Costs 2021

¨If you/spouse worked 40 calendar quarters (4 quarters over 10 years): $0 ¨If you/spouse worked between 30-39 quarters (7.5 years and 10 months: $240/month ¨If you/spouse worked less than 30 quarters (7.5 years): $437/month

Subacute Rehab/Skilled Nursing Facility (SNF)

¨Many nursing homes/long term care facilities have subacute or skilled nursing "units" within the facility ¨Patients admitted to subacute/SNF have a goal of returning home; however that is not always possible ¨If patient is not able to make enough progress for return to home, patient could be transferred from SNF unit to long term care within the same facility ¨In order to remain in a SNF patient must have a need for skilled services. Needing "supervision for safety" does NOT meet this requirement

Subacute/SNF: Patient Population

¨Mostly geriatric, but changing to younger populations now that insurance is more likely to approve SNF rather than acute rehab ¨Medically stable patients with nursing needs and or at least one therapy need ¨Common diagnoses joint replacements, fractures, falls, post acute stay for medical condition (i.e. pneumonia or surgery) ¨Must be able to benefit from one skilled therapy at least 5 days/week (to have therapy covered) ¨Length of stay is varied from 1 week to several months

Nursing Home/LTC: Patient Population

¨Mostly geriatric, but may have a younger resident who is unable to return home ¨Medically stable without any acute medical issues ¨May have chronic issues that need to be monitored ¨No discharge planning as this is the individual's residence

Payment for Medicare B Services

¨No limit on PT treatments; however, If services for PT and Speech exceed $2040 per calendar year then a modifier needs to be placed on the bill and documentation is required to justify the services (includes medical necessity) ¨If services exceed $3000 then a targeted medical review process may occur

Home Care: Patient Population

¨Patients any age, race, ethnicity, sex and diagnosis ¨Some patients are discharged directly from acute care without going to any type of inpatient rehab ¨Pt must be "homebound" to qualify (not just "can't get a ride to therapy") ¨Variety of diagnosis with a variety of complexity ¨Many patients seen in home care still have active medical issues as well as therapy needs

Home Health Care

¨Patients receive care in their homes from PT and/or other healthcare disciplines ¨Focus on safety, making patient's own environment work best for them ¨Usually patients receive home care as a transition between inpatient and outpatient services ¨Required to have skilled needs of one discipline

Outpatient Payment for Medicare Services:

¨Physical therapy services must be deemed medically necessary ¨Medically Necessary ¤PT services directly relate to plan of care based on an individual patient ¤A level of complexity or the condition of the patient shall be such that the services required can be safely and effectively performed only by a qualified therapist (or supervised PTA), and ¤Patient's clinical condition requires the skills of a therapist

Early Intervention (EI)

¨Provide care to children from birth to their 3rd birthday ¨Provide intervention both in the home as well as center based ¨Population is mostly children with congenital and/or developmental issues ¨Children need to qualify for EI by exhibiting a developmental delay (thresholds vary state to state)

Acute Care or General Hospital

¨Provide in-patient care to patients in need of acute serious medical illness ¨May include an emergency department, though some do not ¨May be a large teaching hospital, critical care institution, or smaller community hospital ¨May be a part of a healthcare network or an independent facility ¨May specialize (e.g., Boston Children's Hospital) or provide a breadth of services (e.g. Massachusetts General Hospital)

Nursing Home/Long Term Care (LTC)

¨Provides care for individuals who are unable to return home, who are medically stable ¨Individuals are considered "residents" not patients ¨Most residents are individuals who were not "successful" in their rehab or in a SNF ¨24 hour nursing is on site (many are LPNs with oversight of NPs) ¨Residents may receive intermittent PT services

Long Term Acute Care (LTAC)

¨Provides care for medically complex BUT stable population (less stable than acute rehab) ¨Focus on rehab at a less intense level than acute rehab due to patients' medical status ¨Team consists of interprofessional rehab specialists: PT, OT, Speech, doctor or physiatrist (MD specializing in rehab medicine), nurse, respiratory therapists ¨Doctors must be available 24/7 in-house

Subacute Rehab/Skilled Nursing Facility (SNF)

¨Provides care for non-complex medically stable population who are unable to go home from acute care ¨Focus on rehab and returning to prior level of function ¨Team consists of MD (consults not on site), nursing, PT, OT, perhaps Speech ¨24 hour nursing care, physician can be on-call but not necessarily in building ¨Required to have need for at least one skilled service; Not all patients will get therapy

School Systems

¨Purpose is for students to access the curriculum (schools are mandated to provide services for accessing the curriculum) ¨Goals: students must participate in class, take notes, move from class to class, participate in the curriculum similarly to peers ¨A school is not mandated to provide PT to students who can independently access curriculum, no matter what devices are used

Acute Care: Role of PT

¨Receive "orders" to see patients (not everyone receives PT) ¨Evaluate patients and then establish plan of care including diagnosis, prognosis, short and long term goals, interventions, and discharge plan home or elsewhere ¨Large range of patients from emergency department to intensive care units (ICU) to surgical care to medical care ¨Part of an interprofessional healthcare team with physician leading ¨Frequency: Could be 1x/day or more, multiple days or one visit eval and discharge in same session. ¨Many times PT is consulted to assess if patient is safe to go home or needs services or equipment for discharge to home

Medically Necessary PT Services

¨Services must not only be provided by the qualified professional (or by qualified personnel for incident to services), but they must require, the expertise, knowledge, clinical judgment, decision making and abilities of a therapist that assistants, qualified personnel, caretakers or the patient cannot provide independently. ¨A clinician may not merely supervise, but must apply the skills of a therapist by actively participating in the treatment of the patient during each Progress Report Period. ¨In addition, a therapist's skills may be documented, for example, by the clinician's descriptions of their skilled treatment, the changes made to the treatment due to a clinician's assessment of the patient's needs on a particular treatment day or changes due to progress the clinician judged sufficient to modify the treatment toward the next more complex or difficult task.

Medicare Supplements

¨Some participants buy a Medicare supplement to pay for the 20% balance of what Medicare B covers ¨Sold by a variety of private companies (BCBS, Tufts, Harvard Pilgrim, etc.) ¨Costs vary but are approximately $200/month

School Systems: Patient Population

¨Students are serviced starting on their 3rd birthday up until their 22nd birthday ¨Variety of congenital and developmental diagnoses ¨Students can receive school and outpatient PT at same time, but goals must be different ¨If a student cannot access the public school due to a severe disability, the school must pay for a specialty placement in a more specialized facility

Wellness/Prevention/Fitness

¨US Healthcare system is increasingly aware of the role of prevention to a healthier population ¨Most of these services are paid "out of pocket" as insurance will not reimburse for these services ¨Participant population: everyone but costs can limit access ¨Many "niche" PT practices specialize in wellness/fitness such as yoga, massage, pilates, sport and work injury prevention, return to sport, return to work

Acute Rehabilitation Hospital

¨population ¨Focus on rehab and returning to prior level of function ¨Team consists of interprofessional rehab specialists: PT, OT, Speech, doctor or physiatrist (MD specializing in rehab medicine), nurse, recreational therapists, music therapists, respiratory therapists

Differential the major features of value-based payment and fee-for-service payments

Fee for service: payment for every service rendered, can lead to giving patients care they dont need→ everything the patient does in therapy is paid individually such as paying for ice, hotpack, manual therapy, pt education, etc.. Managed care: per patient capitated basis, fixed payment for patient care for a set period, can be seen as restrictive but incentivizes efficient care→ this is based on how much timed is spent on therapy ie. 1-4 units. This is timed dependent rather than individual category

Copayment

Flat fee for health care encounter paid by the pt and applied at the location where care is received (primary care office, pharmacy)

Understand home health regulatory requirements

Focus on safety and making pt's own environment work best for them Req. to have skilled needs of one discipline Must be homebound Variety of diagnosis and complexity Must still have active medical issues and therapy needs

Differentiate regulatory features of acute hospital admissions, acute rehabilitation hospital admission, skilled nursing facility, and nursing home/long-term care (use materials provided for assigned readings, sides and preparatory work for this module. Focus on regulatory features that are important for physical therapy services SNF/Subacute

Focussed on returning to PLOF 24 hr nurse care, MD can be on call Not all pts get therapy Req. for at least 1 skilled service Therex at least 5 days//week Length of stay 1wk- several months Non - complex medically stable pts Mostly geriatric but can also have younger Joint replacements, fx, falls, post acute stay for med condition Plan for the patients to go home

How is health policy generated (From AMA Introducing health care policy and economics)

Generated when three forces align: 1. Social strategies: a detailed plan or approach to address problem along social infrastructure or systems in place to support strategy → recognized wtf is going on and so you plan to address it and fund it. 2. Scientific evidence: sound data regarding nature of problem to be addressed by a policy→ need data 3. Political will: public understanding and support for resources needed to implement strategy and achieve solution, public is both gov leadership and community policy will affect→ need everyone to sign that "go fund me" page

Medicare Part A

Hospital insurance ¨Covers Inpatient care in hospitals, critical care, skilled nursing home care ¨Could cover hospice and home health, at least in part ¨Does NOT cover custodial or long-term care ¨Premium often paid though payroll taxes, if taxes paid while working

Medicare B

Medical insurance ¨Covers doctor's services, outpatient care, physical and occupational therapy, some home health ¨Does NOT cover custodial or long-term care or services covered with Medicare Part A ¨Premium often monthly by individuals

Understand CPT coding requirements, including the CPT codes for physical therapy evaluation and which patient components are included in CPT evaluation coding: 97163

3+ personal factors, 4+ elements, unstable condition

Medicare Part D

Prescription drug coverage ¨Covers prescription medications ¨Available to everyone who has Medicare ¨Premium typically paid monthly by individuals

Differentiate regulatory features of acute hospital admissions, acute rehabilitation hospital admission, skilled nursing facility, and nursing home/long-term care (use materials provided for assigned readings, sides and preparatory work for this module. Focus on regulatory features that are important for physical therapy services Acute/General Hospital

Provide in-patient care to patients in need of acute serious medical illness Length of stay ~ days-weeks. All population who have SERIOUS medical illness Local residents or out of network Receives "orders" to see pts→ not everyone gets PT Are they safe to D/c Could be 1x/day or more or 1 visit eval with same day discharge

Differentiate regulatory features of acute hospital admissions, acute rehabilitation hospital admission, skilled nursing facility, and nursing home/long-term care (use materials provided for assigned readings, sides and preparatory work for this module. Focus on regulatory features that are important for physical therapy services Nursing Home/LTC

Provides care for individuals who are unable to return home, who are medically stable 24 hr nursing on site Individuals considered "residents" not pt's Mosty geris, medically stable without acute medical issues. May have chronic issues Most residents are individuals who were not "successful" in their rehab or in a SNF May receive intermittent PT Consults only Occasionally resident may have PT for short term or acute issues/functional decline Residents have yearly PT screen

Additional Areas of Practice

Specialty Clinics: Specific populations not generally treated (musicians, dancers, high-level professional athletes) -Military PTs, Police and Firefighter training -Hippotherapy-treating patients using horses -Aquatherapy (pool therapy) -Academia, Research -Adaptive Technology specialists (advanced prosthetics, wheelchair seating, etc..interactions with patient and environment through technology)

Out of pocket max

The most you have to pay for covered services in a plan year. After you spend this amount on deductibles, copayments, and coinsurance for in-network care and services, your health plan pays 100% of the costs of covered benefits.