Summary: The mission of the American Physical Therapy Association (APTA), the principal membership organization representing and promoting the profession of physical therapy, is to further the profession's role in the prevention, diagnosis, and treatment of movement dysfunctions and the enhancement of the physical health and functional abilities of members of the public.

APTA's Vision Statement:

By 2020, physical therapy will be provided by physical therapists who are doctors of physical therapy, recognized by consumers and other health care professionals as the practitioners of choice to whom consumers have direct access for the diagnosis of, interventions for, and prevention of impairments, functional limitations, and disabilities related to movement, function, and health.

Summary: Physical therapists and physical therapist assistants should not underestimate the importance of complete documentation or the implications of deficient documentation. Today's health care system relies on documentation to measure patient outcomes, the need for services, and justification of the plan of care. Insufficient or absent documentation can negatively affect reimbursement, communication among providers, risk management, and most important, the care of the patient/client. In light of the importance of documentation in patient/client care and in response to many of the current issues related to physical therapy documentation, APTA has developed the Defensible Documentation for Patient/Client Management resource as a companion guide to the Association's existing documentation guidelines. The objectives of Defensible Documentation for Patient/Client Management resource include: 1) Raising awareness of physical therapists (PTs) and physical therapists assistants (PTAs) on clinical documentation issues; 2) Providing useable and clinically relevant information about defensible documentation in patient/client care; 3) Identifying legal, regulatory, and payer requirements for clinical documentation; 4) Providing tools and resources PTs and PTAs need to create documentation that will satisfy all the aforementioned requirements.

Summary: Medicare Part B provides coverage for many types of therapy services. This website provides valuable information and serves as a guide to direct professionals to additional resources regarding rehabilitation therapy services, coverage requirements, payment systems, and points of contact for further information.

Summary: The Federation’s vision is that the organization will achieve a high level of public protection through a strong foundation of laws and regulatory standards in physical therapy, effective tools and systems to assess entry-level and continuing competence, and public and professional awareness of resources for public protection.

The Federation of State Boards of Physical Therapy develops and administers the National Physical Therapy Examination (NPTE) for both physical therapists and physical therapist assistants in 53 jurisdictions – the 50 states, the District of Columbia, Puerto Rico, and the Virgin Islands. These high-stakes exams assess the basic entry-level competence for first time licensure or registration as a PT or PTA within the 53 jurisdictions.

Summary: To improve the efficiency and effectiveness of the health care system, the Health Insurance Portability and Accountability Act (HIPAA) of 1996, Public Law 104-191, included "Administrative Simplification" provisions that required HHS to adopt national standards for electronic health care transactions. At the same time, Congress recognized that advances in electronic technology could erode the privacy of health information. Consequently, Congress incorporated into HIPAA provisions that mandated the adoption of Federal privacy protections for individually identifiable health information.

In response to the HIPAA mandate, HHS published a final regulation in the form of the Privacy Rule in December 2000, which became effective on April 14, 2001. This Rule set national standards for the protection of health information, as applied to the three types of covered entities: health plans, health care clearinghouses, and health care providers who conduct certain health care transactions electronically. By the compliance date of April 14, 2003 (April 14, 2004, for small health plans), covered entities must implement standards to protect and guard against the misuse of individually identifiable health information. Failure to timely implement these standards may, under certain circumstances, trigger the imposition of civil or criminal penalties.

The Privacy Rule applies only to covered entities. Individuals, organizations, and agencies that meet the definition of a covered entity under HIPAA must comply with the Privacy Rule's requirements to protect the privacy of health information in multiple formats (written, electronic, and oral) and must provide individuals with certain rights with respect to their health information. If an entity is not a covered entity, it does not have to comply with the Privacy Rule.

Summary: For outpatient rehabilitation providers, the most pertinent portion of this manual is Chapter 15 – Covered Medical and Other Health Services. The two most pertinent sections in Chapter 15 are Section 220 - Coverage of Outpatient Rehabilitation Therapy Services (Physical Therapy, Occupational Therapy, and Speech-Language Pathology Services) Under Medical Insurance and Section 230 - Practice of Physical Therapy, Occupational Therapy, and Speech-Language Pathology. Also, Chapter 12 provides information  specific to Comprehensive Outpatient Rehabilitation Facility (CORF) Coverage.

Summary: For outpatient rehabilitation providers, the most pertinent portion of this manual is Chapter 5 - Part B Outpatient Rehabilitation and CORF/OPT Services. This manual describes policy applicable to Medicare fee-for-service claims, or what is known as the original or traditional Medicare program. The Medicare Managed Care Manual provides claims policy for services to enrollees in managed care plans.

Additionally, Section 10.2 provides detailed information on the Therapy Cap and the Therapy Cap Exceptions Process, and is an excellent reference for therapy providers looking for specific information related to billing for medically necessary services that exceed the therapy cap amounts, and the appropriate use of the KX modifier to indicate an automatic exception should be provided.

Summary: The Program Integrity Manual (PIM) is a critical source of information for Medicare providers. The most pertinent sections for rehabilitation providers in the outpatient setting are:

• Chapter 1, Overview of Medical Review (MR), Benefit Integrity (BI), and Local Provider Education and Training (LPET) Programs;
• Chapter 4, Benefit Integrity;
• Chapter 10, Health Care Provider/Supplier Enrollment;
• Chapter 13, Local Coverage Determinations (LCDs).