Healthcare Law Briefs

Meeting the Challenge of Health Law

	What's Inside
	New "Incident To" Rules Effective July 25, 2005

	CMS Will Not Process Non-HIPAA Compliant Medicare Claims Past 10/01/2005
	CMS Proposes Rules To Permit Requests For Waiver Of Medicare Exclusions

Healthcare Law Briefs

August 15, 2005

*READ PAST ISSUES OF THE HEALTHCARE LAW BRIEFS

1. New "Incident To" Rules Effective July 25, 2005

As of Monday, July 25, Medicare will only pay for physical therapy services provided in physician offices "incident to" the physician's services if the physical therapy services are provided by "qualified personnel" as defined in a June 24 transmittal to Medicare contractors. The immediate implementation of the standards follows the dismissal last week in a Texas federal court of a lawsuit filed by the National Athletic Trainers Association (NATA) challenging the personnel standards, as explained in a new MedLearn article (click here for the article) released by the Centers for Medicare and Medicaid Services.

In addition to the implementation of the personnel requirements for physical therapy services provided incident to a physician/NPP, Section 230.5 of the Medicare Benefit Policy Manual also clarifies the requirement that services provided by PTAs cannot be billed incident to the physician/NPP's services. PTAs must be supervised by a physical therapist in all treatment settings, including in a physician/NPP office. The services of PTAs are covered under the benefit for physical therapy services and not under the benefit for services provided incident to a physician/NPP. In order to bill for the PTA's services in a setting where the PT and PTA are employed by a physician/NPP, the PT would need his or her own Medicare provider number. Payment for physical therapy services billed using the PT provider number would then be reassigned to the physician/NPP.

Physicians may bill for therapy services as incident to services only if the ancillary personnel meet the qualifications of 42 CFR 484.4, which require that the individual must at least be a graduate of a training program. These individuals need not be licensed unless required by state law. Pennsylvania requires licensing for physical therapists, occupational therapists and speech and hearing therapists.

Contact Kent Culley at kculley@tuckerlaw.com if you have any questions.

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2. CMS Will Not Process Non-HIPAA Compliant Medicare Claims Past 10/01/2005

As of October 1, 2005, CMS will reject non-HIPAA compliant Medicare claims. HIPAA originally required HIPAA compliance for electronic healthcare transactions as of October 16, 2003. However, only approximately 31% of claims were compliant at that time, so CMS adopted HIPAA contingency plans for non-compliant transactions. Now that non-compliance for Medicare FFS claims is only .5%, CMS is terminating the contingency plans for those transactions, and plans to end the contingency plan for remittance advice soon thereafter.

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3. CMS Proposes Rules To Permit Requests For Waiver Of Medicare Exclusions

On August 4, 2005, CMS published procedures for providers who have been excluded from Medicare to request CMS to request the OIG to waive that exclusion. (Fed. Reg. Vol. 70, No. 49, 44879). For more information, contact Mike Cassidy at mcassidy@tuckerlaw.com.

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>For more information about the topics presented in this newsletter please contact one of the Healthcare Attorneys: