Ron, I raise the question about "impact" to help assess the situation. There are many problems out there in search of solutions. There are state laws on the books that state OTs fabricate artificial limbs. Is that accurate? Well no, probably not, but it is not at the top of the list to fix right away. When that particular OT statute comes up for review we'll work to make a change.
We get many calls from members saying things like "Medicare is no longer paying for OT." That is their assumption; you need to peel back the layers of the onion to see what the problem is. It could be a change in the LCD. It could be improper documentation. It could be that the payer inappropriately denied the claim. In your case you've uncovered a problem because of a denial. Did the provider type vs. specialty type trigger the denial or was it something else? We are having problems with the wound care code in a number of places because wound care isn't specifically listed in the state practice act. Which is one reason why the new model practice act includes wound care, because OTs are being challenged by payers and other health professionals. Of course there is also a debate within the OT community about wound care--how does it relate to occupation, why is the intervention being performed in the first place. We hear from some folks that the OTs provide the service because the PT is too busy or on vacation. That is the wrong reason and does not help with our credibility in this area of practice. Fred Somers is the Executive Director of AOTA and I did read the that column. (http://www.aota.org/ajot/abstract.asp?IVol=59&INum=2&ArtID=1&Date=March/April%202005). I believe this is the quote that you are referring to: "In viewing the prospects that lie ahead for occupational therapy, I am optimistic and enthused about the opportunities the future holds. There is no question that we face a difficult environment. Changes in the organization and delivery of health care services and reforms in reimbursement systems driven by federal and state budget pressures have profoundly affected occupational therapy practice. All health care professionals are increasingly being required to demonstrate the effectiveness and appropriateness of their services. Resource constraints have fostered challenges to the traditional domains of many professions. Nonetheless, as a profession that offers unique services that are ideally suited to meet the health, participation, and quality of life needs of people of all ages, occupational therapy is well-positioned to succeed and flourish in the 21st century. The philosophy and conceptual models of occupational therapy and the needs of society are intersecting to create great opportunities for the future. The full realization of occupational therapy's potential however will depend on vision, strategy, and unity of effort within the professional community." In my mind the future of OT will not be driven by staff or what the PTs are doing or not doing. It is up to OT to define itself. A couple of years ago my department was tasked to revise a chapter in OT Manager (a common OT textbook published by AOTA). At the beginning of each chapter the is quotation. It wasn't until we complete the chapter did we look for a quote. This is the quote: "Occupational therapists are the only people who can and should define our practice, education, ethics, values and research. We owe this much to society and the people we serve." -Elizabeth Yerxa I think that occupational therapists need to work through their state and national professional associations to "make things happen." There are over 120,000 OT/OTAs in the workforce, yet there are only 30,000 OT/OTA members in AOTA. Chuck >>> [EMAIL PROTECTED] 10/25/2005 2:04:23 PM >>> Impact, now that's a good question. Honestly, the only reason I posted it was to raise awareness. It seems that at many levels, OT suffers from a lack of awareness - from doctor's not knowing about us, to insurance companies who don't cover our services, to OT's who don't know about these inequities. Raising awareness is the same reason why I posted the message about Ask Jeeves' definition of OT. And all of this goes back to Fred Sommers' (spelling?) statement about OT being posed to be a premier provider of therapy services. In my opinion and experience, OT is far behind PT on almost every level, that it's not even funny. All this is not to say that PT is our standard, but the sad reality is that on some (many) levels, they are our direct competitors. Now, I know there are many therapists who have great friendships and working relationships with PTs, and so have I, but we SHOULD not kid ourselves into believing that as a profession, PT is our ally, well at least in areas that are competitive. Am I encountering problems, well actually, the whole reason this became an issue is because First Coast denied payment for a wound care procedure simply because of my speciality. And come to find out, their own documentation conflicts because it supports payment for my provider type (i.e. PT) but not my speciality (i.e OT). They are unsure of what to do and I am confused as to why there's no provider type for OT. Ron ----- Original Message ----- From: Charles Willmarth <[EMAIL PROTECTED]> Sent: Tuesday, October 25, 2005 To: OTlist@OTnow.com <OTlist@OTnow.com> Subj: [OTlist] Medicare and OT CW> Ron, CW> I guess my question is, what is the impact? Are you encountering CW> problems because of this? CW> Chuck >>>> [EMAIL PROTECTED] 10/25/2005 12:17:34 PM >>> CW> Chuck, what you've found are the SPECIALITY codes, not the CW> PROVIDER CW> TYPES. CW> Yes, there is a speciality code for an OT in PP, but there is NOT CW> a CW> provider type for an OT. I am unsure if this is a FCSO 'problem' or CW> a CW> CMS problem. CW> By the way, you are great researcher. CW> Ron CW> ----- Original Message ----- CW> From: Charles Willmarth <[EMAIL PROTECTED]> CW> Sent: Tuesday, October 25, 2005 CW> To: OTlist@OTnow.com <OTlist@OTnow.com> CW> Subj: [OTlist] Medicare and OT CW>> Ron, CW>> I found this list of MEDICARE PROVIDER/SUPPLIER SPECIALTY CODES. CW>> Interestingly I don't see a provider type 31. CW>> CW> http://www.floridamedicare.com/1common_resource_enroll_Provider_Supplier%20Specialty%20Codes.asp#TopOfPage CW>> 25 - Physical Medicine and Rehab. CW>> 31 - no listing CW>> 65 - Physical Therapist (Private Practice) CW>> 67 - Occupational Therapist (Private Practice) CW> -- CW> Unsubscribe? CW> [EMAIL PROTECTED] CW> Change options? CW> www.otnow.com/mailman/options/otlist_otnow.com CW> Archive? CW> www.mail-archive.com/otlist@otnow.com CW> Help? CW> [EMAIL PROTECTED] -- Unsubscribe? [EMAIL PROTECTED] Change options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com Help? [EMAIL PROTECTED] -- Unsubscribe? 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