Custom Mobility marks dividing line between ATPs, therapists

LARGO, Fla. - The issue of ATPs “scribing” or completing medical justification documentation for therapists has come to a head for Custom Mobility.

The company recently sent out an email notifying therapists in its area that the practice potentially violates self-referral laws and anti-kickback statues, because it allows therapists to bill for more services and it allows certain ATPs to become referrals of choice.

“It has gotten to the point where therapists are telling our ATPs, 'If you're not going to provide me with assistance, I'm going to refer my business elsewhere,'” said Barbara Berenger, funding and billing director. “We felt we had to try and come up with a more formal way to make sure they're getting the right information.”

Both CMS and the American Occupational Therapy Association (AOTA) have indicated the practice is wrong—if an ATP assists in documentation in any way, they are providing a service to the therapist “in kind,” the organizations say.

But Custom Mobility and other stakeholders would like to see CMS's stance in writing, something they hope happens at the next DME MAC council meetings in November.

“We have submitted it as a formal question for clarification to both Noridian and CGS,” said Dan Fedor, director of reimbursement for U.S. Rehab, a division of the VGM Group. “It's not officially answered in writing anywhere.”

There are a number of reasons why the arrangement has proliferated, stakeholders say, including pressure for therapists to increase their productivity, and pressure for providers to obtain timely and complete documentation.

“Therapists often don't produce good documentation,” Fedor said. “It's not hard to see a provider saying, 'We can help you,' and a therapist saying, 'We'll take it.'”

Stakeholders advise providers to fight the issue by providing therapists with guides outlining coverage policies, offering them training and sending them the appropriate procedure billing codes.

“We also do in-services,” said Berenger. “We try to let them know what's expected of them through a number of different programs.”