The American Physical Therapy Association (APTA), Alexandria, Va, is calling on the Centers for Medicare and Medicaid Services (CMS) and Congress to act to prevent unqualified personnel from providing physical therapy services, following the release of a federal report on physician "incident to" services (services that are billed by physicians but are performed by nonphysicians) billed in 2007 under the Medicare program.
The report, released by the Office of Inspector General (OIG) of the Department of Health and Human Services, found that when Medicare allowed physicians more than 24 hours of services in a day, half of the services were not performed personally by a physician.(1) It also found that unqualified nonphysicians performed 21% of the services that physicians did not perform personally. Additionally, 49% of rehabilitation therapy services (including primarily therapeutic exercise, massage therapy, ultrasound therapy, therapeutic activities, and electrical stimulation) performed by nonphysicians were furnished by staff not trained as therapists and who the OlG found to be unqualified.
Medicare rules require that physical therapy services provided "incident to" the professional services of a physician be furnished by a graduate of a professional physical therapist program, or a nurse practitioner, clinical nurse specialist, or physician assistant if allowed by state law. Medicare is authorized to only pay for services provided by individuals trained specifically in physical therapy.
In the report’s executive summary, the OIG says, "Services performed by unqualified nonphysicians represent a risk to Medicare beneficiaries. . . We are concerned about the potential scale of this problem."
OIG recommends that physicians only bill for services provided by nonphysicians who have the necessary training, certification, and/or licensure pursuant to state laws and Medicare regulations, and that claim forms reflect that physicians are billing for services only provided by nonphysicians with the appropriate qualifications. It also recommends that CMS take appropriate action to address claims for "rehabilitation therapy services performed by nonphysicians who did not have the training of a therapist." APTA says it strongly supports these recommendations to ensure that Medicare beneficiaries only receive physical therapy services from licensed physical therapists.
The sample for the report included only those physicians who billed for more than 24 hours of services in a day. "However, we have no reason to believe that the issues identified in this review are unique to these physicians," said the OIG.
(1) US Department of Health and Human Services. Prevalence and qualifications of nonphysicians who perform non physician services. http://oig.hhs.gov/oei/reports/oei-09-06-00430.pdf. Published August 2009. Accessed August 10, 2009.