It's official: starting June 13, physical therapists in certain areas will be able to bring in another licensed PT to treat Medicare patients during temporary absences for illness, pregnancy, vacation, or continuing medical education, and bill Medicare for the services.
And just as the new provisions begin, the old term for the concept—"locum tenens"—will be discontinued, according to the Centers for Medicare and Medicaid Services.
In a transmittal published May 12, CMS announced that "reciprocal billing and fee-for-time arrangements" under Medicare part B will be extended to PTs in health professional shortage areas (HPSA), medically underserved areas (MUA), or in CMS-designated rural areas (any area outside of a Metropolitan Statistical Area or Metropolitan Division). The change, triggered by the passage of the 21st Century Cures Act signed into law in December 2016, was 1 of APTA's top public policy priorities.
Under the new provisions, Medicare administrative contractors (MACs) are instructed to pay the regular PT for the services of a substitute PT, regardless of whether those services were provided through a reciprocal billing arrangement or if the PT pays the substitute in a per diem or other fee-for-service arrangement. In any case, it will no longer be called a "locum tenens" arrangement, CMS explains, because the term tends to be associated with only the fee-for-time approach, and its continued use in this expanded system could be confusing to the public.
"The startup of these provisions is good news for PTs, but a real victory for many patients across the country who can now experience continuity of care," said Michael Matlack, APTA director of congressional affairs. "We're pleased that the work we did with our Private Practice Section resulted in this important step forward."
It's important to note that the change is limited to certain parts of the country designated by CMS as a HPSA, MUA, or "rural area." PTs can find out if they're practicing in a HPSA or MUA by visiting the Health Resources and Service Administration (HRSA) website. Finding out about rural areas is a little trickier: the information is available on a webpage devoted to the final rule's data files. To get at the Excel file with the relevant information, scroll down to a gray "Downloads" box and open a file titled "County to CBSA crosswalk file and urban CBSAs and constituent counties for acute care hospitals." The areas left blank in the excel sheet are the ones CMS has designated as rural.