National Athletic Trainers' Association (NATA) Statement Regarding Therapy-Incident to Services and OIG Report on "Physical Therapy Billed by Physicians"

Contact: Robin Waxenberg - (212) 489-8006 rwaxenberg@nyc.rr.com Ellen Satlof - (214) 637-6282, ext. 159 ellen@nata.org DALLAS, May 15 – The National Athletic Trainers’ Association (NATA) today commended the HHS Office of Inspector General (OIG) for its on-going efforts to ensure that all therapy services, whether provided in a physician’s office or other setting, meet the requisite Medicare standards for payment. It is unfortunate, but not surprising, that the OIG has identified numerous documentation errors with regard to the delivery of therapy services in a physician’s office. The findings of the most recent OIG report, “Physical Therapy Billed by Physicians” (1), is almost identical in its findings to a report issued last year by the OIG which looked at Medicare claims for physical and occupational therapy services provided by PTs and OTs in private practice (2). In the case of both reports, the OIG found that more than 90 percent of claims submitted failed to meet Medicare’s requirements for payment due to improper documentation, failure to have a “plan of care” or because someone other than the PT provided the services. NATA President Chuck Kimmel, ATC, in response to the OIG report stated, “Medicare beneficiaries and taxpayers deserve to know when providers bill for therapy services, regardless of the setting, those services are medically necessary, appropriate and provided by qualified health professionals. NATA supports this premise.” Physicians in increasing numbers are turning to state licensed or certified athletic trainers to deliver high quality, cost-effective therapy services in their offices. Just last year, the Medicare Payment Advisory Commission (MedPAC) noted that based upon 2002 payment data, the most cost-effective place for Medicare beneficiaries to obtain physical therapy was in the physician’s office, which supports the long-standing practice of providing “therapy-incident to.” (4) Average $581.00 Physician $405.00 Hospital OPD $429.00 PT in Private Practice $653.00 OT in Private Practice $594.00 Skilled Nursing Facility $868.00 Significantly, these findings were substantiated by the May 2006 OIG report which notes that despite the fact that a very small number of physicians are responsible for a significant number of claims, the average cost per beneficiary for therapy services provided in the physician’s office has actually declined since 2002, to $305 per beneficiary (1). “NATA has been promoting legislation to ensure that when Medicare beneficiaries receive therapy services in a physician’s office, those services are medically appropriate, supervised and directed by a physician and delivered by a qualified health professional, which includes athletic trainers,” said Kimmel. NATA promotes this legislation because CMS has improperly interpreted existing law as it relates to incident to therapy services. Along with calling for legislation, NATA continues to maintain its legal challenge to the CMS therapy-incident to rule. NATA asserts that CMS has incorrectly interpreted the existing statute, which clearly permits physicians to supervise a variety of health care providers providing therapy in their offices. MedPAC supports the continued supervision of physical therapy by physicians, as discussed in a December 30, 2004 study on “the feasibility and advisability of allowing Medicare fee-for- service beneficiaries to have ‘direct access’ to outpatient physical therapy (PT) services and comprehensive rehabilitation facility services.” The report determined that physician supervision and referral remain in the best interest of Medicare beneficiaries. (3) NATA strongly supports a team approach to the delivery of health care and has called on Congress to enact legislation recognizing there are a range of health professionals licensed, certified and well-trained to work with physicians to provide therapy services.

  1. May 2006, “Physical Therapy Billed by Physicians,” OEI-09-02-00200, http://www.oig.hhs.gov/oei/reports/oei-09-02-00200.pdf
  2. March 29, 2005, "Results of the Medical Reviews Performed on Selected Medicare Claims for Physical and Occupational Therapy Services Provided During Calendar Year 2002 in the State of Texas,” OIG Report Number A-06-03-00085, http://www.oig.hhs.gov/oas/reports/region6/60300085.pdf
  3. December 30, 2004, MedPAC report letter to The Honorable Richard B. Cheney, president of the Senate, regarding “study the feasibility and advisability of allowing Medicare fee-for-service beneficiaries to have ‘direct access’ to outpatient physical therapy (PT) services and comprehensive rehabilitation facility services,” http://www.medpac.gov/publications/congressional_reports/Dec04_PTaccess.pdf
  4. December 28, 2005, MedPAC, Medicare basics: Outpatient Therapy Services, http://www.medpac.gov/publications/other_reports/Dec05_Medicare_Basics_O...
 
Share this