Strategies for Medicare A/B Supervision

Strategies for addressing “line of sight” supervision of students when patient/client services are covered by Medicare Part A

•      Use open treatment areas and gyms
•      Use alternative means of clinical education that do not involve patient care such as    solving evidenced based patient problems or interacting with other disciplines
•      Student performs a portion of the examination and/or interventions under the supervision of the physical therapist and/or physical therapist/physical therapist assistant team when involved in multiple patients

Strategies for student learning when patient/client services are not covered by Medicare Part B

•    Students conduct comprehensive chart audits/reviews
•    Students participate in patient satisfaction interviews
•    Student conducts screening
•    Student provides a case study presentation to demonstrate critical thinking processes
•    Students provide prevention/screening for specific patient populations or groups
•    Students conduct ergonomic assessments for office staff on campus
•    Students provide an aquatics program for children in public school with developmental   disabilities
•    Student and CI switch roles. Student directs CI in patients examination/intervention, demonstrates clinical decision mailing, and student “checks” CI. Ensures that the licensed physical therapist provides direct patient care.

Other strategies

•    Clinical site conducts research on different types of clinical education experiences to determine most effective approaches and models.
•    Use clinical specialists to provide clinical education experiences in the community and to teach in the didactic curriculum.
•    Use of student/clinician teams that include various combinations such as physical therapist/patient teams, teams comprised of more health care professionals with students.
•    To maximize space and provision of services; provide part-time clinical education experiences late in the day (i.e. 4-7 PM) in settings such as outpatient clinics.
•    Provide internships with mentors/students as employees after graduation and have students complete their licensing examination like the medical model
•    Use of areas of clinical practice that may be externally supported and funded (e.g. pediatric respiratory care) to broaden patient/client learning. For example, physical therapist assistant students could be provided a better understanding of pediatric respiratory care through such an exposure, without performing as PTAs to broaden their understanding of pediatric diseases.
•     Provide early clinical experiences that are shorter in duration and rich in observational experiences

Strategies for Learners

•    Learners take the initiative to check patient’s method of reimbursement
•    Value observational and “hands-off” learning experiences – record observations, analyze patient/client movement, hypothesize diagnosis, suggest interventions, ways to provide more efficient care, evidence-based literature in support of interventions
•    Consider the internship as a job opportunity to assess performance expectations, send resumes to the clinical facility and consider an interview prior to leaving the experience.
•    Conduct student projects that benefit the clinical site/clinicians (e.g. track reimbursement process for a PT from admission to discharge)

Medicare B and Clinical Education

Strategies for Clinical Education Site 

Facilities need to cease seeking reimbursement for services provided by students to patients with Medicare Part B to comply with the April 11, 2001 HCFA Program Memorandum.

•    Clinical education sites need to be apprised of the status of this regulation and be responsible foensuring that all clinicians at the site are informed of the regulation and its current clarification.
•    Patient care provided by students is not reimbursable for patients with Medicare Part B. However, this regulation only applies to outpatient services, whereas student minutes can count for patients with Medicare Part A in SNFs where the supervising therapist is within “line of sight.”  Thus, this regulation does not apply to all types of clinical settings. For information about student reimbursement under Medicare in other practice settings see the reimbursement area of the web site.
•    Clinical facilities might consider a different patient mix to provide student clinical learning experiences.
•    Consider how to enrich the clinical learning experience to include observation of clinicians performing components of the patient management model at varied levels of clinical experience/expertise.
•    Develop skills that students associate with “hands-off” care such as peer review, quality assurance, understanding administrative management, billing procedures, education and documentation, and the review of current research in support of tests and measures and interventions.
•    Provide opportunities for students to strengthen their clinical reasoning abilities by seeking evidence tojustify care delivered; compare observational learning experiences of similar patient diagnoses, and to develop a systematic approach to patient examination.
•    Provide opportunities for students to be exposed to other health providers who cooperate to provide patient care as part of the team.
•    Use approaches to scheduling student learning experiences with patients involving the licensed physical therapist that: (1) ensures the licensed physical therapist has contact with the patient on each visit to be reimbursed for patients with Medicare Part B, and (2) supervision of the students is in line of sight for patients with Medicare Part A (e.g. wave scheduling used with medical students).
•    Consider other ways students can be provided with learning experiences such as supplemental teaching strategies, assisting the physical therapist in providing care as a second pair of hands, and assisting in developing a plan of care.