205: What You Must Know About Medicare Maintenance Therapy And What Can Happen If You Don’t With Robbie Leonard, PT, DPT, CHC

Who wants to talk about a fun topic?! What if learning about Medicare Maintenance Therapy actually was fun and didn’t make you fall asleep? Well, that’s what you’re going to get on today’s episode! We sat down with our favorite Medicare Utilization Reviewer, Dr. Robbie Leonard, PT, DPT, CHC to discuss the hot and sticky points about Medicare skilled therapy. We know a LOT of US-based therapists have questions and we’re here to help! In today’s show we discuss some common misconceptions about using Medicare for therapy so we can help you pass an audit and stay out of trouble! 

Some of the topics covered today include:

• Medicare’s definition of medical necessity and when it does and does not cover services
• The only 2 standards under which you can treat - restorative and maintenance and what they each mean
• When do to restorative and when to do maintenance and why you should NOT mix the two
• The questions you should ask yourself every time you see a patient: Could what I’m doing be provided by a caregiver or technical person that I train? If yes, it should not be billed at all.  Unfortunately it doesn’t matter whether there is a qualified caregiver available or not.
• How you get audited: You can be flagged to be audited because your data profile looks different. If you always use or never use KX you can be audited for being an outlier. You should never stop seeing people just because they’ve reached the threshold. This can be a red flag!
• What you should NEVER say to a patient about their Medicare dollar usage
• When it is and is not appropriate to stop providing skilled therapy (hint: it doesn’t have to do with where the patient is in their threshold spend!)
• How to know if you can provide more therapy to a person who’s reached their threshold for the year: evaluations will always be covered! 
• Why you should not be concerned (or turn away) a patient who has used up to their Medicare threshold or beyond Initial threshold
• What about Medicare and cash? If you’re providing a covered service you cannot opt out of Medicare as a therapist. You are legally obligated to file a claim.
• What does wellness look like then?
• What does a reasonable time frame actually look like?

Jimmo settlement CMS

Medicare regulations all US therapists should read: Medicare Benefit Policy Manual Chapter 15, Section 220.2 D

NeuroSpark members find the Parkinson Focus Track call recording with Robbie HERE with additional information covered

Find Robbie at: [email protected]

**Please note, the contents in this episode are for educational purposes and should not be considered legal advice