Income for Private PT clinic

[ProZackMI]

Yes, unfortunately we have a reputation of being highest defaulters on student loans when it comes to doctors. Chiropractic is a tough market, you have lousy insurance reimbursement for the most part, and you are pretty much on your own when you graduate. You will have to open your own clinic or work for a DC who will pay you enough to make your student loan payment and that's about it. Oh yeah not only do you have to deal with that you also have to deal with the know-it-all medics trash talking your profession. If MD's in private practice didn't have the hospitals and the insurance companies funneling them new patients they would defaulting on their loans. I think people here would better serve Jesse by telling him to avoid healthcare all together. Insurance is going down the tubes and people will not pay out of pocket for what the insurance pays. You think a patient will pay $200-$300 a visit for PT or an ortho consult out of pocket? They won't even want to pay the family doc for a $70 office visit. One thing about chiropractic is many people already pay cash, they're use to it, and they've been conditioned like Dental patients. Medical doctors on the other hand rely on insurance and when it disappears they'll be workin for all the chiropractors.

Yes, we have some quacks just like they do, we have doctors who dupe patients just like they do. What's your point? Since your profession is larger than ours, you probably have more quacks and scammers than any healthcare profession.

While much of what you said here is nonsense (such as MDs working for chiros one day), you made some valid points. Medicine, and health care in general, is not what it used to be. I'm only 35 and haven't been a doctor that long, but I'm already on my way out. After residency, I went to law school, while working full-time, and am now practicing law part-time and hopefully soon, will join with a health care law firm full-time.

Managed health care, at least in the US, has forever tainted the health care professions. To be honest, from what I've seen, the only profession that continues to do well is dentistry. Jesse, if you're reading this, have you have ever thought about dentistry? It's four years after college and once you graduate, there is no residency. It's a great income and a great lifestyle. Dentists do very well no matter where they live in the US. Also, many areas of specialization. Managed health care hasn't mucked up dentistry like it has medicine, chiro, PT, podiatry, psychology, optometry, etc.

Another factor to consider is the proliferation of mid-level practitioners in the US. Here, MDs and DOs in primary care are being replaced by foreign medical grads (mostly from India, Asia, and Mid East) and PAs (Physician Assistants) and NPs (Nurse Practitioners). I know there are many FMGs in Canada as well, but the PA-NP trend hasn't caught on over there. It will. Once it does, MDs and DOs in primary care will make even less. Soon, you'll have DNP degreed NPs popping up and moving over into former MD territory. Medicine is a mess. PhD/PsyD psychologists are getting presriptive authority in many US states. ODs also have prescriptive authority and are enhancing their scopes of practice. DPTs are cropping up everywhere and will want more autonomy and authority. Audiologists are now clinical doctorates (AuD) and becoming more like optometrists. Pharmacists have doctorates too and are increasing their clinical roles.

One day, in fifty years, you'll have opometrists and NPs performing surgeries, more PA specialists, more NP specialists, pharmacists performing physical exams (already being done in many states with CPPs (clinical pharmacist practitioners), psychologists doing testing and writing scripts/admitting into hospitals/ordering labs, and PTs ordering imaging, etc. Meh, health care is a nightmare.

So, Jesse, if you're out there, don't take the plunge into unknown and potentially dangeours waters. Do some soul-searching and give it some serious thought. What else would you like to do? There are many options. Don't just go with chiro or PT.

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[ProZackMI]

Yes, unfortunately we have a reputation of being highest defaulters on student loans when it comes to doctors. Chiropractic is a tough market, you have lousy insurance reimbursement for the most part, and you are pretty much on your own when you graduate. You will have to open your own clinic or work for a DC who will pay you enough to make your student loan payment and that's about it. Oh yeah not only do you have to deal with that you also have to deal with the know-it-all medics trash talking your profession. If MD's in private practice didn't have the hospitals and the insurance companies funneling them new patients they would defaulting on their loans. I think people here would better serve Jesse by telling him to avoid healthcare all together. Insurance is going down the tubes and people will not pay out of pocket for what the insurance pays. You think a patient will pay $200-$300 a visit for PT or an ortho consult out of pocket? They won't even want to pay the family doc for a $70 office visit. One thing about chiropractic is many people already pay cash, they're use to it, and they've been conditioned like Dental patients. Medical doctors on the other hand rely on insurance and when it disappears they'll be workin for all the chiropractors.

Yes, we have some quacks just like they do, we have doctors who dupe patients just like they do. What's your point? Since your profession is larger than ours, you probably have more quacks and scammers than any healthcare profession.

Psychiatry/clinical psychology share many things in common with chiropractic. There are many quacks in my profession. I admit it. I see so many misdiagnoses it's not even funny. Do you know how many people out there hold an Axis I Dx of Bipolar I or II when, in fact, they are merely depressed (unipolar NOS)? Do you know how many "schizoprenics" are really suffering from substance-induced psychosis? Do you know many kids are diagnosed with ADD/ADHD when they have no such dx? THOUSANDS!

There are psychiatrists and psychologists out there who see the same patient for years, on a weekly or monthly basis, with NO improvement. How many other doctors would think that's accepable for a patient without a systemic, life-long condition (e.g., diabetes, asthma, etc.?). I mean, as an internist, I'd see patients with conditions like that every 3-4 months for a basic check-up and script renewal and labs, but every month/week with no improvement? WTF.

So, in a way, you have the mental health subluxation theory out there. You come in, whine and complain, Dr. Feelgood gives you a "mental adjustment" and you're all better until next week/month. HEH. What a crock. Most psychiatrists and therapists are also afraid to confront patients with the truth. "Mr. Jones, you're primary problem is that you're a lazy fat drunk and you take out your aggression on your wife and kids." or "Ms. Smith, your life isn't that bad when compared to most people's lives and you're just a whiney b|tch who doesn't realize how good you have it!" No, that wouldn't be therapeutic, would it?

Mental health is filled with unprofessional quacks. So, you're right. I admit that. I went through medical school just like any other doctor. I finished step I and II. I did a residency just like any other MD. However, I occasionally am told that psychiatrists aren't real doctors. I sometimes hear that I don't practice medicine. I have MDs try to explain medical concepts and terms to me forgetting that I'm an MD. I get called a psychologist frequently...or worse...a SOCIAL WORKER. Psychiatry is one of the least respected med specialties out there. You should see the reactions I get when I tell people what I do for a living. I imagine it's similar to chiropractic, huh?

 

[ONstudentPT]

Hey Prozack,

It does seem like health care is a little messy in the states from that post your wrote and I am sure you can find someone who will complain in every field even law, and dentistry. With that being said ..I have the utmost respect for MDs and I really doubt that they will ever have to worry about finding a job and making a decent living at least here in Canada. Do you think Law will really be that much better becaue I have heard some discouraging stories about it as well?

 

[ONstudentPT]

Oh and Jesse... are you there .. I am waiting for your explaination..?

 

[BackTalk]

Zack, I said the comment about MD's working for chiropractors jokingly. We both know that would never happen. I share much of what you have said about insurance and also about quackery. You seem like a good guy, I know all psychiatrists aren't quacks and I hope you see that we are not all quacks either. I'm sure you get upset when people blanket all Psychiatrists as quacks. I feel the same way with regard to chiropractors. We have people in our profession who have no business practicing. What they think chiropractic is and what it can do is absolute nonsense and they have NO scientific proof that what they say is true. We can argue with them day after day but when you ask for proof, they will throw some bogus study at you and you will easy shred it to pieces. Then they will just weasel their way out of answering your questions. I see it here all the time. In order for chiropractors to gain some recognition they need to do some good research on what subluxations are and what the effects they have on the body. Do chiropractic adjustments make the nervous system function more efficiently? I really wish there was some good solid research to prove this but I have never seen any. Chiropractors just don’t have it when it comes to research. We just don’t have the training to conduct and analyze research. The research classes I had in college were really weak. I have come across many MD’s and DO’s and they always demand research, they have a great understanding and easily point out the flaws. This is something I have a hard time doing.

I for one have never use the term subluxation; it has no meaning to me other than the medical definition. You ask 10 chiropractors what it is and I bet you get ten different answers. I practice neuromuscular care and that’s about it. I also do acupuncture as well but for pain mostly. I also do clinical nutrition but really its geared towards NMS complaints. I don’t sell supplements but I will recommend Omega’s for chronic inflammation or perhaps glucosamine and some other things. I am not against the medical establishment or medications. They have their place. Of course I do have some qualms with some but I’m sure many medical doctors do as well. I prefer working with medical doctors not against them. I just wish the quacks in our profession didn’t ruin it for all of us.

FoughtFyr, nice to hear from you! I will shoot you a PM.

 

[ONstudentPT]

Zack, I said the comment about MD's working for chiropractors jokingly. We both know that would never happen. I share much of what you have said about insurance and also about quackery. You seem like a good guy, I know all psychiatrists aren't quacks and I hope you see that we are not all quacks either. I'm sure you get upset when people blanket all Psychiatrists as quacks. I feel the same way with regard to chiropractors. We have people in our profession who have no business practicing. What they think chiropractic is and what it can do is absolute nonsense and they have you scientific proof that what they say is true. We can argue with them day after day but when you ask for proof, they will throw some bogus study at you and you will easy shred it to pieces. Then they will just weasel their way out of answering your questions. I see it here all the time. In order for chiropractors to gain some recognition they need to do some good research on what subluxations are and what the effects they have on the body. Do chiropractic adjustments make the nervous system function more efficiently? I really wish there was some good solid research to prove this but I have never seen any. Chiropractors just don’t have it when it comes to research. We just don’t have the training to conduct and analyze research. The research classes I had in college were really weak. I have come across many MD’s and DO’s and they always demand research, they have a great understanding and easily point out the flaws. This is something I have a hard time doing.

I for one have never use the term subluxation; it has no meaning to me other than the medical definition. You ask 10 chiropractors what it is and I bet you get ten different answers. I practice neuromuscular care and that’s about it. I also do acupuncture as well but for pain mostly. I also do clinical nutrition but really its geared towards NMS complaints. I don’t sell supplements but I will recommend Omega’s for chronic inflammation or perhaps glucosamine and some other things. I am not against the medical establishment or medications. They have their place. Of course I do have some qualms with some but I’m sure many medical doctors do as well. I prefer working with medical doctors not against them. I just wish the quacks in our profession didn’t ruin it for all of us.

FoughtFyr, nice to hear from you! I will shoot you a PM.

Backtalk,

You seem like a pretty down to earth guy. I just want to give you some perspective on why I have given Jesse14 the advice I have. During my undergrad years I was trying to figure out whether to go into chiro or physio. I could have easily gotten into chiro but decided to go into physio instead. Now I know that there are chiros out there who are ethical and treat neuromuscular conditions in a similar way as a physio would. So I looked at it this way ... I could go into chiro pay 4x the amount in tution, worry about paying back all those loans, have no other real option but to open my own clinic, I have to spend my time defending my profession due to all the quaks out there, not get as much support from the mainstream health care system, worry about competing with all the other chiros which have completely saturated the field .. or go into physio .. have the option of opening my own clinic ( with real direct access available everywhere here in Canada), still maintain a good relationship with mainstream health care, get trained specifically in physio and still have the option to take manual therapy courses and use them to relieve lower back pain just like a chiro can, not have to constantly defend my profession and deal with the bad stigma, save a lot more money on tutition, get my PhD if I want to and do research at a university and if for some reason my clinic doesnt work out I still have the peace of mind that I would be able to find a decent paying job anytime. That was my logic when I made my decision. Doesnt it make sense?

 

[jesse14]

Hey jesse,

Ok before I write anything I just want to let you know that you seem like a very nice individual and have no intention of bashing you as a person.

Thank you.

I will explain to you what I find misleading and confusing about some of your posts. Can you please explain to me what is going on here because its hard to have a discussion with someone who you are not sure is being truthfull.

You said your GPA is 3.67. But in this post you say that your GPA is 3.1
--->http://www.chiroweb.com/ubb/students/Forum4/HTML/000009.html

Then you go on to say that your GPA was actually 3.3 when you wrote that and that you got straight A's in third year. Now even if you had a 4.0 GPA in your 3rd year (which is extremely difficult to pull off)but had only a 3.3 GPA for you first 2 years .. your GPA could not be a 3.67 .. the math just doesnt add up ... so what is the truth then.... are just confused about your GPAs or are you lying? Jesse the thing is that marks are very important cause they can open doors so its important to know where you stand.

OK, here is my story. You seem like a great person so i don't mind being honest to you about what happened in my life. Back in 1st year and the first bit of 2nd year i was going through a lot of probelms. I was heavely depressed and denied i ever had depression (big mistake) and my mother had a severe stroke mid way through 1st year. So i went to see a psychologst who dx'ed me with having depression which i did have and still battle from time to time. Where do the grades come into this i bet you're wondering? Due to my situation i did poorly in school at that time and managed about a 3.1 GPA. I did well in some thing (a few A+s in full year classes really bump up the GPA) but did crapy in other things ( a few C-'s in some courses). So, in third year of university my life got straightened out and i did much better. I received alost straight A's and a few B+'s. So when i told you my GPA was 3.67 i did mis lead you.. i admit it. MY 3rd year GPA is 3.67 and the GPA i used to ask my Question on chiroweb was my 1st year gpa. I know PT schools only look at your final 2 years for admissions decisions so i only gave my 3rd year GPA. I hope to do as well or if not, better in my 4th year at York. I hope that clarifies a few things or ya. If not, ask away.


Now the other thing I find confusing is this whole issue with your dad being a chiro.. maybe you can explain it to me a little better. If my dad was a chiro and owned his own chiro clinic and I was as interested about becoming a chiro as you seem to be I would know every aspect of his business and know exactly what his gross income, his net income, how many pateints he sees ect.. ect... Also if my dad was a chiro I wouldnt be worried about asking peoples thoughts about chiro on this forum because my dad would be able to give me any and all the information I would need to know especially conerning CMCC if he went there. And lastly if he owned such a successful chiro business and told me that the future was bright... I really wouldnt be worried about my future because I know once I graduated I could work with my dad and eventually take over his successful business.

Thank's for letting me know what YOU would do in my shoes but i'm not you and have chosen to broaden my knowledge base beyond that of my dad's practice. My dad is not the be all and end all of chiropractic and IF i want to make a career out of this, i want as much information from as many sources as possible. My dad doesn't know everything and i don't see what's wring or even confussing about trying to get others takes on the profession.

As for the not being worried about the future part... I like to think it worst cases cenarios and if for some reason i couldn't take over his practice i still want to know that i could survive as a DC. I guess i'm just covering all my bases is all.

Can you see from my perspective how that just doesnt make sense is this really your dad or just some chiro you know? Can you explain that to me?
I guess i see your confusion but i hope i've layed it to rest. If not, i'm always happy to try and explain more. And my dad is a DC. In my last post i even gave u a link to his page on yellow pages (your favorite web site lol). How else would you like me to prove to you he's my father?


Get back to me and let me know whats up.

Done

Take Care

Same to you


Oh and by the way, i wrote a hell of a lot on that 2 part post and all you chose to respond to is my grades??? I did all of that work for nothing!! lol
I'm sure there are other parts you can respond to in my 2 part post... isn't there?

 

[jesse14]

[/B]

Same to you


Oh and by the way, i wrote a hell of a lot on that 2 part post and all you chose to respond to is my grades??? I did all of that work for nothing!! lol
I'm sure there are other parts you can respond to in my 2 part post... isn't there?

Oh yeah, please forgive my spelling. I had to write that (and this) very quickly... late for work

 

[PublicHealth]

PhD/PsyD psychologists are getting presriptive authority in many US states.

I think it's only two: NM and LA. Have you heard differently?

One day, in fifty years, you'll have opometrists and NPs performing surgeries, more PA specialists, more NP specialists, pharmacists performing physical exams (already being done in many states with CPPs (clinical pharmacist practitioners), psychologists doing testing and writing scripts/admitting into hospitals/ordering labs, and PTs ordering imaging, etc. Meh, health care is a nightmare.

I agree that this appears to be where healthcare is headed. Frankly, I see no problem with it, as long as the care provided is safe and effective.

 

[BackTalk]

ONstudentPT, it makes total sense. 15 years ago I was going to be a physical therapist. This was at a time win the profession was really booming. I took all the courses I needed to apply got accepted only to find out I was accepted but had a year and a half wait. At the time my brother was in chiropractic school and that's really how I came to know what chiropractic was. I never new there was any animosity between chiropractors and other health professions. I had no clue how it was on the outside. I didn't find out what I had gotten into to after I started practice. I remember being in a small town, I ran a clinic on my own that was owned by two other chiropractors. We had a medical facility right next door. One day my x-ray processor jammed and I called the place next door to see if they would be so kind to take some lumbar films for me. They wanted nothing to do with me. They said my patient would have to be seen by their doctors and the doctor would decide what was needed. They were jerks. That was my first experience with medical doctors. Now you can see where young chiropractors develop hostility towards the medics. Then you would family doctors telling your patient when they went to see them that chiropractic was going to cripple them and not to go. I have had medical doctors tell patients straight up that we are witch doctors. I never knew this type of behavior existed. Then you find out there are two types of chiropractors, the "mixers" and the "straights", and I'm not talking sexual preference. I never knew this profession was split down the middle. I never knew my degree was pretty much worthless outside of my field. I was young and naive. Not to mention the discrimination that goes on with insurance companies. All claims are suspect when submitted by a chiropractor . If I would have known what I know now I would have pursued physical therapy or osteopathy. Now I think Dentistry would have been a nice option. Anyway, I don't completely regret my decision to be a chiropractor. I have helped a lot of people when other forms of treatment failed. Chiropractic has been good to me and I was able to be successful doing what I feel chiropractic is good at, and that's treating back pain. If we all would just stick to backs like dentists stick to teeth, we all would be so much better off. We would probably be so busy we wouldn't know what to do. Chiropractic is a tough market, since I opened my own location we have had 14 other chiropractors come to town. This is in the last 7 years. Competition is furious here and now we have MD's buying traction units and doing decompression. My practice has dropped off do to all of this but I'm determined to get all the quack chiros patients in my town. Many of them unfortunately force patients into accepting year care plans. It's a joke! If you come in for a low back complaint or a headache it's always a year of care. It makes me wanna puke when I hear this. I call them donation practices as patients will not typically return as every time they have a backache, minor or not, it's a year of care. They force the patient to sign contracts and prepay for their care. Patients feel stuck once they have been duped. Really they aren't stuck but they don't now that. You come to me and I get you out of pain, stabilize your problem and you are out the door only to return as needed. My treatment plans have a beginning, middle and an end. Its not a lifetime of care like many DC's try to sell patients. Unlike these chiropractic gangsters of healthcare who dupe people, I do the right thing. This is why patients return to me.

Jesse kind of has his foot in the door; his father is a great chiropractor and indeed has built a successful practice. He's going to retire someday and that would be a great opportunity for Jesse.

 

[wayttk]

Yes but you are leaving aside the HHS OIG report against chiropractic. Trust me, chiro bashing aside, government reports like that are used to cut government funding (as it should be in this case). Like it or not, the writing is on the wall in Washington. I would bet we see Medicare/medicaid coverage for chiropractic cut within the next cycle or two. The VA will be right behind.

- H

This is misleading. It was not "against chiropractic"..... it concerned claim errors by DCs. The OIG had alot to say of other providers also. As for cutting DC coverage in Medicare.........there is currently a medicare project that is covering expanded DC services. VA coverage of DC services is also expanding.


http://www.cms.hhs.gov/media/press/release.asp?Counter=905


As shown by the new detail in this year's report, the provider types that had the most errors nationally were physical therapists (18.2 percent), internists (13.5 percent), and chiropractors (11.3 percent), Providers with the lowest errors were ambulance services (4.7 percent), podiatrists (4 percent) and urologists (5.3 percent). The findings also indicate which contractors have a large number of providers that submit improper claims.

In a recent report by the Office of Inspector General (OIG) of the Department of Health and Human Services, the OIG found that 91% of physical therapy services billed by physicians in the first 6 months of 2002 failed to meet program requirements, resulting in improper Medicare payments of $136 million.

Based on a simple random sample of 70 physical therapy line items biled by physicians and
rendered in the first 6 months of2002, we found that 91 percent of physical therapy biled by
physicians and allowed by Medicare during the first 6 months of 2002 did not meet program
requirements, resulting in $136 milion in improper payments. In addition, we analyzed
Medicare claims data from 2002 to 2004 and identified aberrances in physicians biling patterns
and unusually high volumes of claims. Finally, based on our review, we identified a number of
issues associated with physical therapy biled by physicians under the "incident to"

CMS Cracks Down on Billing for Physical Therapy 'Incident to' Physician Services


Reprinted from the May 30, 2005 issue of REPORT ON MEDICARE COMPLIANCE, the nation's leading source of news and strategic information on false claims, overpayments, compliance programs, billing errors and other Medicare compliance issues.

CMS will no longer pay physicians for physical therapy performed in their offices unless it's provided by a licensed physical therapist. Starting June 6, physical therapy provided "incident to" a physician's professional services must be performed by licensed physical therapists, according to Change Request 3648.

Medicare pays regular physician fees for incident-to services performed by physician extenders, therapists and other auxiliary staff as long as physician supervision and other requirements are fulfilled. In the physical therapy arena, physicians have collected full Medicare payments for physical therapy provided in their offices even when it was performed by other professionals, such as massage therapists, athletic trainers, physical therapy aides and kinesiologists, says Jean Acevedo, president of Acevedo Consulting Inc. in Delray Beach, Fla.

"I can't tell you how many orthopedic practices employ people like athletic trainers and bill Medicare for physical therapy," she says. "But those individuals' services are no longer covered services."

After June 6, physicians risk overpayment recoupment or perhaps false claims accusations if they bill Medicare for incident-to physical therapy that isn't provided by a registered physical therapist. Therapy generally is a big compliance risk area and a frequent target of Medicare auditors.

The May 6 change request states that "contractors shall deny payment of the services provided incident to the physician if the person who performed the service does not meet the qualifications for qualified therapists as defined in Medicare manuals, with the exception of the licensure requirements." CMS notes that "qualified personnel have been educated and trained as therapists and qualify to furnish therapy services only under direct supervision incident to a physician or NPP [non-physician practitioner]."

Physicians might overlook this crackdown because it appears in the context of broader changes to the Medicare therapy benefit. Change Request 3648, which modifies Pub. 100-02 (Medicare Benefit Policy), also clarifies policies on orders, visits, plans of care, certifications and private practice.

Meanwhile, CMS will now require registered physical therapists and occupational therapists to get their own Medicare provider numbers, even if their services are billed incident to a physician, meaning that only the physician's Medicare provider number is on the claim. "That's a new thing," Acevedo says. However, if the physician employs physical therapy assistants, their services will be billed under the physical therapist's provider number, not the physician's, Acevedo says.

Change Request 3648 can be found at AIS's Government Resources.
CMS Cracks Down on Billing for Physical Therapy 'Incident to' Physician Services






The May 6 change request states that "contractors shall deny payment of the services provided incident to the physician if the person who performed the service does not meet the qualifications for qualified therapists as defined in Medicare manuals, with the exception of the licensure requirements." CMS notes that "qualified personnel have been educated and trained as therapists and qualify to furnish therapy services only under direct supervision incident to a physician or NPP [non-physician practitioner]."

Physicians might overlook this crackdown because it appears in the context of broader changes to the Medicare therapy benefit. Change Request 3648, which modifies Pub. 100-02 (Medicare Benefit Policy), also clarifies policies on orders, visits, plans of care, certifications and private practice.



Change Request 3648 can be found at AIS's Government Resources.
http://www.aishealth.com/Compliance/ResearchTools/RMC_CMS_Physical_Therapy.html



Physical Therapy Utilization. According to the WCRI, physical therapists were involved in more cases under California’s workers’ compensation system than in the median state in the study. Injured workers made 39 percent more visits to physical therapists per claim compared to similar injuries in other states.

http://www.calchamber.com/CC/Headli...nceCommitteeToImplementSubstantialReforms.htm

 

[lawguil]

Originally posted by Wayttk

The findings also indicate which contractors have a large number of providers that submit improper claims.

In a recent report by the Office of Inspector General (OIG) of the Department of Health and Human Services, the OIG found that 91% of physical therapy services billed by physicians in the first 6 months of 2002 failed to meet program requirements, resulting in improper Medicare payments of $136 million.

Based on a simple random sample of 70 physical therapy line items billed by physicians and
Rendered in the first 6 months of2002, we found that 91 percent of physical therapy billed by
physicians and allowed by Medicare during the first 6 months of 2002 did not meet program
requirements, resulting in $136 million in improper payments. In addition, we analyzed
Medicare claims data from 2002 to 2004 and identified aberrances in physicians billing patterns
and unusually high volumes of claims. Finally, based on our review, we identified a number of
issues associated with physical therapy billed by physicians under the "incident to"

Below is a link to a report by the OIG dated March or 2005, about a year before the report that you cited that shows that over 99% of a hundred sample claims from physical therapists did not meet CMS guidelines because the therapist did not maintain proper documentation, they did not meet the plan of care requirements or someone other than the billing therapist performed the services! Of the one hundred cases reviewed, therapists received $57,253 for services that should not have been billed to Medicare.
When billed by a physical therapist 99% didn't meet Medicare guidelines and when billed by a physician "incident too" had a 91% rate.

http://www.oig.hhs.gov/oas/reports/region6/60300085.pdf

By this standard, we should be very concerned about over billing and fraud when it comes to PT providing rehabilitation services. Physicians who billed for Physical medicine and rehabilitation only had 91% of their claims that didn’t meet CMS guidelines according to the OIG compared to PT’s who were over 99%.


CMS Cracks Down on Billing for Physical Therapy 'Incident to' Physician Services

Reprinted from the May 30, 2005 issue of REPORT ON MEDICARE COMPLIANCE, the nation's leading source of news and strategic information on false claims, overpayments, compliance programs, billing errors and other Medicare compliance issues.

CMS will no longer pay physicians for physical therapy performed in their offices unless it's provided by a licensed physical therapist. Starting June 6, physical therapy provided "incident to" a physician's professional services must be performed by licensed physical therapists, according to Change Request 3648.

Medicare pays regular physician fees for incident-to services performed by physician extenders, therapists and other auxiliary staff as long as physician supervision and other requirements are fulfilled. In the physical therapy arena, physicians have collected full Medicare payments for physical therapy provided in their offices even when it was performed by other professionals, such as massage therapists, athletic trainers, physical therapy aides and kinesiologists, says Jean Acevedo, president of Acevedo Consulting Inc. in Delray Beach, Fla.

"I can't tell you how many orthopedic practices employ people like athletic trainers and bill Medicare for physical therapy," she says. "But those individuals' services are no longer covered services."

After June 6, physicians risk overpayment recoupment or perhaps false claims accusations if they bill Medicare for incident-to physical therapy that isn't provided by a registered physical therapist. Therapy generally is a big compliance risk area and a frequent target of Medicare auditors.

The May 6 change request states that "contractors shall deny payment of the services provided incident to the physician if the person who performed the service does not meet the qualifications for qualified therapists as defined in Medicare manuals, with the exception of the licensure requirements." CMS notes that "qualified personnel have been educated and trained as therapists and qualify to furnish therapy services only under direct supervision incident to a physician or NPP [non-physician practitioner]."

Meanwhile, CMS will now require registered physical therapists and occupational therapists to get their own Medicare provider numbers, even if their services are billed incident to a physician, meaning that only the physician's Medicare provider number is on the claim. "That's a new thing," Acevedo says. However, if the physician employs physical therapy assistants, their services will be billed under the physical therapist's provider number, not the physician's, Acevedo says.

Change Request 3648 can be found at AIS's Government Resources.
CMS Cracks Down on Billing for Physical Therapy 'Incident to' Physician Services
The May 6 change request states that "contractors shall deny payment of the services provided incident to the physician if the person who performed the service does not meet the qualifications for qualified therapists as defined in Medicare manuals, with the exception of the licensure requirements." CMS notes that "qualified personnel have been educated and trained as therapists and qualify to furnish therapy services only under direct supervision incident to a physician or NPP [non-physician practitioner]."

This is all a crock of sh**. This is the work of lobbying efforts by the APTA to have a monopoly in the physical rehabilitation setting. 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.”
http://www.medpac.gov/publications/..._Basics_OPT.pdf

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 making it even more cost effective to provide physical medicine and rehabilitation in the physician office.
http://www.oig.hhs.gov/oei/reports/oei-09-02-00200.pdf

People like athletic trainers have a solid history of providing "incident too" physical medicine and rehabilitation in the physicians office that is more cost effective, accessible, and with a higher rate of meeting Medicare guidelines than physical therapists. Physical Therapists are simply taking every measure to pave the way for direct access and to eliminate competition.

 

[jesse14]

ONstudentPT, no more questions regarding my history?? I like talking to you, don't leave now.. the conversation is stimulating.

Take care

Oh yea, my age has no baring on my ability to converse with people older than me and more educated than myself. I learn from these people and i really don't like when you belittle me due to my age. Don't tell others not to talk to me because of my age. Judge me on my dialogue, not my age please. Are you saying 21 year olds can't discuss and question their career ambitions with those who are older and wiser? I would hope not.

 

[ONstudentPT]

Hey Jesse14,

Ok you cant honestly compare dentist with the same level of negativety that chiro is associated with. The grades issue makes a little more sense although I am not sure why you would have wanted to be misleading in the first place. For physio they do look at your last two years (sub-GPA) but if you are in your 4th year applying they will go back to take your last semester in 2nd year and then take all of your 3rd year and your first semester of your 4th. Thats why some people have to wait a year and apply again if thier grades were too low in 2nd year.

Now whether your dad is a chiro or not .. i dont know.. i just cant be sure .. the fact that you were trying to be misleading with you grades is a little suspicious.. If your dad is a chiro I would say he is the best source for all your questions and concerns...and why wouldnt you be able to take over his clinic.. if my dad had a succesfull physio clinic I wouldnt be too worried and I would know everything there is to know about it....with that being said I am not going to call the clinic you referred to in the yellow pages to see if you are telling the truth .. just seems a little too weird for me ... but it really is irrelevent at this point...SO I will take your word for it! (end of disscusion)

You were wondering if I was concerned about my future ... umm yes and no... I would like to run a successful physio clinic someday but just like with any business nothing is for sure so on that front I am a little worried. .... but the good thing about physio is that I dont think I will ever have to worry about finding a job and making a decent living even if it is at a hospital. If I really need money .. I could work multiple jobs and working 50 hours a week .. I could prolly make some where in the range of 80-100 thousand. If I just want to relax and work like 30-37.5 hours a week make around 50-75 thousand with full benifits and paid vacations I could do that as well. I too once had the choice between chiro and physio and if you read the message I posted for Backtalk you can see how my logic worked toward picking physio and even if I didnt get into physio I would have went to teachers college and became a phys. ed. teacher ( also did my undergrad in kinesiology) it would have been a good lifestyle with decent pay and no headaches.

I know it must be fraustrating and stressfull to figure out what to do. I would say again just to go with your gut feeling and try to really look inside and figure out what that is. Things could turn out ok but then they could also turn out really bad... are you willing to take that risk and spend you soo much money and time on it?

If you can take over an established and succesfull business then you might be ok and be able to survive. BUt even then you cant be sure what the future holds for the chiro profession as a whole. OHIP has already cut off chiros .. what if all the insurance companies are next(extended benifits, wsib, MVA) I know they are already putting some serious limitations on chiro. Also what will happen if some quack pretends to be an MD and doesnt get the patient the proper care and the patient dies or if some irresponsible chiro does some neck manipulations that causes a stroke .... the media eats this kinda stuff up and if just a few of these cases start to really get a lot of media attention ... I think chiro as a profession would be in some serious trouble.

Anyways those are just some more of my thoughts

Take care

 

[jesse14]

Hey Jesse14,

Ok you cant honestly compare dentist with the same level of negativety that chiro is associated with. The grades issue makes a little more sense although I am not sure why you would have wanted to be misleading in the first place. For physio they do look at your last two years (sub-GPA) but if you are in your 4th year applying they will go back to take your last semester in 2nd year and then take all of your 3rd year and your first semester of your 4th. Thats why some people have to wait a year and apply again if thier grades were too low in 2nd year.


well under those admissions criteria, as long as i do well in my 1st semester of 4th year i shouldn't have too much troube getting into a PT program in Ontario. Thank's for the information.

Now whether your dad is a chiro or not .. i dont know.. i just cant be sure .. the fact that you were trying to be misleading with you grades is a little suspicious.. If your dad is a chiro I would say he is the best source for all your questions and concerns...and why wouldnt you be able to take over his clinic.. if my dad had a succesfull physio clinic I wouldnt be too worried and I would know everything there is to know about it....with that being said I am not going to call the clinic you referred to in the yellow pages to see if you are telling the truth .. just seems a little too weird for me ... but it really is irrelevent at this point...SO I will take your word for it! (end of disscusion)

Just truste me... that's my father. And about the grades. I'm actually not sure how much i mislead you. You used my GPA to ases whether i could get into a PT program or not correct? Well if PT schools only look at 2nd semester of 2nd year, all of 3rd year and 1st semester of 4th year than my GPA i told you (3.67) is pretty accurate. Why are you understanding my rational for asking other DCs about chiropractic?? I'm starting to sound like a broken record but here it goes again... i choose to broaden my knowledge base beyond that of my dad's prcatice. My dad doesn't know everything. He's not a lot but i like knowing what other DC's think about any given topic i might come up with. As far as taking over his practice. I intend to... just not sure of the logistics as of et. He'll still be working a lot by the time i become a DC so i'm not sure how it would work but hopefully we'll come to an agreemnet when the time arises. I'm not quite sure why you assume i have to live up to what "you would do". This is not the 1st time you have told me what you would do if you were in my position. I understand where your coming from but once again, i'm not you and have just a bit more understanding of my own life's circumstances than you.

You were wondering if I was concerned about my future ... umm yes and no... I would like to run a successful physio clinic someday but just like with any business nothing is for sure so on that front I am a little worried. .... but the good thing about physio is that I dont think I will ever have to worry about finding a job and making a decent living even if it is at a hospital. If I really need money .. I could work multiple jobs and working 50 hours a week .. I could prolly make some where in the range of 80-100 thousand. If I just want to relax and work like 30-37.5 hours a week make around 50-75 thousand with full benifits and paid vacations I could do that as well. I too once had the choice between chiro and physio and if you read the message I posted for Backtalk you can see how my logic worked toward picking physio and even if I didnt get into physio I would have went to teachers college and became a phys. ed. teacher ( also did my undergrad in kinesiology) it would have been a good lifestyle with decent pay and no headaches.

You sound like you got a solid idea of how and where you want to practice. I wish you the best in all your future endevours.

I know it must be fraustrating and stressfull to figure out what to do. I would say again just to go with your gut feeling and try to really look inside and figure out what that is. Things could turn out ok but then they could also turn out really bad... are you willing to take that risk and spend you soo much money and time on it?

Great question and it's still one i struggle with almost dailey. There's no easy answer yet but the more i know, the easier that choice will become.



If you can take over an established and succesfull business then you might be ok and be able to survive. BUt even then you cant be sure what the future holds for the chiro profession as a whole. OHIP has already cut off chiros ..
Didn't OHIP also cut physio and optometry at the same time it cut chiro??


what if all the insurance companies are next(extended benifits, wsib, MVA) I know they are already putting some serious limitations on chiro.

It's funny how we can have such different takes on the same topic. More and more insurance companies are added partial coverage (usually $500 a year) for chiro. I know my schools health insurance includes chiro. WSIB has actualy included full coverage for in home assesments done by DC's. To the best of my knowledge, a PT can't do that.

Also what will happen if some quack pretends to be an MD and doesnt get the patient the proper care and the patient dies or if some irresponsible chiro does some neck manipulations that causes a stroke .... the media eats this kinda stuff up and if just a few of these cases start to really get a lot of media attention ... I think chiro as a profession would be in some serious trouble.

Do you watch the news?? Do you see how many stories they show of medical mishaps and stuff like that? Tht's NOT to bash MD's at all but i just said to point out that every professional is under the scruteny of the media. NOt just chiro. Besides, did you here about the Lewis case? Unfavorable results were shown there and chiro surrived. Every patient that walks into a DC ofice signs an informed consent that outlines the slight risk of a c-spine manipulation. Nothing is hidden from the patient.

Anyways those are just some more of my thoughts
As always, your thoughts are appreciated!

Take care

Same to you!

Just curious, are you in Hamilton now for Pt school out are you on summer break?

 

[jesse14]

[/B]

Same to you!

Just curious, are you in Hamilton now for Pt school out are you on summer break?

ONstudentPT,

Are we done with these discussions?

 

[ONstudentPT]

Hey Jesse14,

If you are really interested in PT you need to have at least a 3.7GPA in you last 2 years to have a solid shot but it seems like you are set on Chiro in which case even with a 3.0 GPA you can get in with no worries.

My point is not to tell you what I would do. The point is that if someone who is as interested in chiro as you seem to be and has a father who is chiro for 20 years would know a lot more about certain aspects of the chiro business and would not need others input because who would know more about chiro in Ontario than a chiro who has worked in Ontario for 20+ years. Some of the quesitons you ask just dont make sense if you has all this knowledge in your reach. IT just doenst make sense to me why you wouldnt ask your dad. Here is another example of questions you ask which could be answered by your dad very easily: http://forums.studentdoctor.net/showthread.php?p=4102243#post4102243

This doenst make sense to me:
"Well if PT schools only look at 2nd semester of 2nd year, all of 3rd year and 1st semester of 4th year than my GPA i told you (3.67) is pretty accurate."

How could you consider that accurate when you said yourself that you are just going into 4th year now.


"Didn't OHIP also cut physio and optometry at the same time it cut chiro??"


OHIP was cut temporarily but PT is covered under OHIP again. From What I heard Chiros are capped at the number of visits which are covered by some insurance.



"WSIB has actualy included full coverage for in home assesments done by DC's. To the best of my knowledge, a PT can't do that."

PT do home visits and school visits and long-term care visits....



"Do you watch the news?? Do you see how many stories they show of medical mishaps and stuff like that? Tht's NOT to bash MD's at all but i just said to point out that every professional is under the scruteny of the media. NOt just chiro"

The difference is that Chiro as a profession is already associated with a stigma and I believe has come and would come under much more scrutiny.




PT students get a month off in august and I am starting classes again very soon.

Jesse14 good luck on your future. I hope you make the right choice for yourself and can figure out what that is. IF you start chiro in a year let me know how things are going post it in this thread/site.

Good luck