Pediatric Physical & Occupational Therapy Services, LLC Pacific Northwest Pediatric Therapy, LLC

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1 , LLC, LLC The ffices f Rsemary White, OTR/L & Assciates Main Office Suth End Office Prtland Office Ped PT & OT Services Ped PT & OT Services Pacific NW Pediatric Therapy th Ave NE 6617 S 193 rd Pl, Suite P SE Milwaukee Ave Shreline, WA Kent, WA Ph: [Call, Fax r Main Office] Ph: Fax: pnpt1@cmcast.net pedptt@cmcast.net T ur new clients, We are accepting new clients and lk frward t wrking with yu. Rsemary White is the wner and directr f Pediatric Physical and Occupatinal Therapy Services and, she is very actively invlved in all aspects f the practices and in mentring all ur therapists (we currently have 12 therapists.) Rsemary lectures extensively natinally and internatinally and because f her lecture schedule, which frequently takes her away frm the clinic, she is nt persnally accepting new clients hwever she wrks very clsely with the therapists and their clients! Our main ffice is lcated nrth f Seattle in Shreline, WA. We als have ffices suth f Seattle and in. Our practice is dedicated t prviding therapy; therefre appintments are scheduled in ne-hur sessins, primarily between the hurs f 8 AM and 5 PM, Mnday thrugh Friday. We will schedule a regular weekly therapy appintment fr yur child. The sessins are ne-hur in length, the same time each week and the appintment will remain yurs fr as lng as necessary. It is pretty standard fr a child t have therapy ne hur per week fr up t 12 mnths. The first fur appintments are the evaluative treatment sessins the gals fr therapy and treatment plan are established at these sessins. The therapist lks at fur primary areas, sensry prcessing (sensry mdulatin, sensry regulatin, sensry discriminatin and mtr planning); auditry prcessing, grss and fine mtr skills, scial skills and behavir. The Occupatinal Therapy assessment is prvided t understand functinal difficulties that yur child may be experiencing and the unique sensry prcessing challenges that may cntribute t these difficulties. We recmmend that bth parents attend the evaluative sessins. Please arrange childcare fr siblings during these sessins as it is imprtant fr yu t be able t give yur full attentin yur child and the therapist. During all evaluative sessins the parents are present and are ften included in the evaluatin prcess. In at least ne f the evaluative treatment sessins a play assessment is cnducted in which the parent and the child play tgether fr fifteen minutes (Functinal Emtinal Assessment Scale, FEAS).The FEAS is a standardized play assessment during which we are lking t find the types f

2 play when yu and yur child find enjyment and engagement. If ther standardized testing is apprpriate it may include tests f balance and crdinatin, grss and fine mtr skills, visual perceptin, sensry perceptin and/r mtr planning. All evaluative treatment sessins include clinical evaluatin during which the therapist bserves the child s pstural and behaviral respnses while playing n therapy equipment. Our gal fr the evaluatin is t wrk with yu. Fr many families this includes direct caching f the parents t facilitate engagement and interactin thrugh bth play and daily activities. The first fur evaluative treatment sessins are videtaped and yu will be prvided with a cpy n DVD fr yur recrds. The DVD will include the therapist s impressins and recmmendatins. Yu will als receive an written reprt with recmmendatins. Yur child s Occupatinal Therapist des nt make a medical diagnsis and cannt prvide dcumentatin f medical necessity fr treatment if required by yur insurance cmpany. T receive a medical diagnsis r a letter f medical necessity, please cntact yur child s physician. The first steps in scheduling an appintment Cntact the ffice t prvide yur name, yur child s name and age, initial intake infrmatin regarding yur child s medical histry, yur main cncerns fr therapy and yur child s specific needs. Cmplete and return the intake infrmatin (Instructins fr cmpletin and return f the intake questinnaire are included n the questinnaire) Seattle Offices: Pediatric PT & OT Services at th Ave NE, Shreline, WA Prtland Office: Pacific NW Pediatric Therapy at 4305 SE Milwaukie Ave, Fr ur Seattle ffices, upn receipt f the cmpleted intake questinnaire we will place yur child s name n ur appintment list t be scheduled. (Yur child s name will nt be n ur appintment list until we receive the cmpleted questinnaire.) We will d ur very best t schedule an appintment as quickly as we can and t make yur waiting time as shrt as pssible. Hwever, because appintments ften remain filled fr extended perids f time, it is frequently necessary fr children t be placed n an appintment list prir t being scheduled. Waiting times vary based n the lcatin requested (main r suth end ffice) and the time f the year yur intake is received. The beginning and end f the schl year are usually ur busiest seasns and we usually we receive an influx f intakes at these times. Fr ur Prtland ffice, we will cntact yu upn receipt f the cmpleted intake t discuss scheduling. We will d ur best t accmmdate yur scheduling requests and t begin therapy as sn as we can. Often we are able t schedule services upn receipt f yur intake infrmatin. 2

3 Prir t beginning services Prvide ur ffice with a written prescriptin frm yur child s physician fr Occupatinal Therapy (we rely n yu t maintain a current prescriptin that cvers all dates f service.) If yur child s prescriptin is written fr a certain perid f time r fr a certain number f visits then we rely n yu t request an updated prescriptin frm yur physician prir t expiratin t avid a break in cverage by yur insurance. Bring the prescriptin t yur first appintment r request that the physician fax it t ur ffice. If the physician faxes the prescriptin, please fllw up with us t make sure it was received and is n file at ur ffice prir t yur first appintment. Failure t prvide a prescriptin culd cause insurance t deny payment f yur claims. As claims are being prcessed r reviewed fr payment, mst insurance cmpanies require a physician s written prescriptin fr therapy (t establish prf f medical necessity.)our practice prvides Occupatinal Therapy using a variety f appraches. Please request that yur physician write the prescriptin specifically fr Occupatinal Therapy and that he/she include the diagnsis r reasn fr the therapy and the duratin f the therapy. (We suggest yu initially request the prescriptin be written fr nce a week fr up t 12 mnths t limit requests fr updated prescriptins frm yur physician.) We will bill the insurance with the diagnsis shwn n the prescriptin. It is very imprtant that yur physician des NOT use Sensry Integratin as the type f the therapy requested r as the diagnsis fr therapy. Unfrtunately insurance cmpanies will deny payment f claims if referred fr Sensry Integratin therapy and they will deny services that are prvided fr the diagnsis f Sensry Integratin Dysfunctin (as this is nt an fficial diagnsis in the ICD-9 cde bks and insurance cnsiders it t be investigatinal in nature). Examples f diagnsis cdes that we ften use when billing insurance are: Dyspraxia r mtr planning difficulty (ICD-9 cde 781.3) and Hyptnicity r less than nrmal muscle tne (ICD-9 cde 728.9). These diagnsis cdes are typically cnsidered Neurdevelpmental Therapy cdes and mst likely wuld nt meet criteria f medical necessity fr rehabilitatin services (see belw fr infrmatin n NDT.) Please discuss the apprpriate diagnsis fr therapy with yur physician when requesting the initial prescriptin/referral. Cntact yur insurance t verify that we are cntracted with yur plan and t cnfirm yur cverage and benefits fr Occupatinal Therapy. If yu find that we are nt cntracted, please ask abut ut f netwrk benefits fr nn cntracted prviders. (The easiest way t identify us with yur insurance cmpany is with ur tax ID number. (Pediatric PT & OT Services, Seattle TIN is and Pacific NW Pediatric Therapy TIN is ) Insurance cmpanies ften ask 3

4 fr the billing cdes when prviding benefits r preauthrizatin infrmatin. We use the billing cde (CPT r prcedure cde) fr therapeutic activity. The billing diagnsis cde (ICD-9) is taken frm yur physician s prescriptin r referral. It is imprtant t cntact yur insurance cmpany t verify yur eligibility and benefits prir t beginning therapy. Mst ften insurance cmpanies prcess claims fr Occupatinal Therapy under Neurdevelpmental Therapy (NDT) fr children 6 years and yunger and as a rehabilitatin service fr children 7 years and lder. (Please see belw fr specific infrmatin based n yur child s age.) If yur insurance cmpany requires an authrizatin fr services then we rely n yu t btain and update the authrizatin as required and t verify all necessary paperwrk is n file with yur insurance cmpany befre yur child begins therapy. Please cntact yur insurance and physician fr necessary extensins prir t the expiratin f the authrizatin r referral. This will help maintain cntinuity f care and avid a break in services while waiting fr insurance re-apprval. If a prgress reprt r therapy ntes are required t update the authrizatin we are happy t prvide the paperwrk but rely n yu t let yur therapist knw as far in advance as pssible (1 mnth minimum) t allw her time t prepare the necessary paperwrk. We rely n yu t fllw up with yur insurance t verify the status f the extensin r authrizatin. It is imprtant fr yu t keep track f the expiratin date f all referrals, prescriptins r authrizatins and update as necessary as we d nt have a way t keep track f the number f visits used relative t thse authrized by the physician r insurance cmpany. If yur plan has a cntract limit (maximum dllar amunt r number f visits) fr Occupatinal r Neurdevelpmental Therapy then we rely n yu t keep track f the amunt f benefits yu have received s that yu will knw when reach yur cntract maximum. We are nt able t track it fr yu. In rder t receive the mst accurate infrmatin regarding benefits fr yur child s therapy, we recmmend that yur physician request a predeterminatin r preauthrizatin f benefits. This is a review and guarantee f benefits (prvided by yur insurance cmpany) prir t services being prvided. Mst insurance cmpanies require that a physician initiate the request fr preauthrizatin and they require infrmatin frm the physician t establish prf f medical necessity fr the services being apprved. The prcess t cmplete a preauthrizatin and the infrmatin required are based n yur specific insurance cmpany and plan. We hpe that taking this extra step will help yu make financial arrangements and avid unexpected financial difficulties that may ccur if yur insurance determines that services are nt cvered after the services have already been prvided and charges are incurred. We are available t assist with any questins yu may have. 4

5 Fr children 7 years r lder, it is ur experience that mst ften insurance cmpanies d nt cver the cst f Occupatinal r Physical Therapy unless the child s diagnsis meets criteria f medical necessity fr rehabilitatin services (an illness r injury with date f nset r date f injury.) We recmmend that yu ask yur insurance cmpany very specifically if yur plan cvers Occupatinal Therapy under rehabilitatin services fr children 7 years r lder. If it des, then we suggest that yu ask if yur child s diagnsis meets the criteria f medical necessity and if Occupatinal Therapy will be cvered fr yur child s specific diagnsis. Hpefully these questins will help yur insurance prvide accurate benefit infrmatin. Rehabilitatin services are mst ften paid nly fr services fllwing an illness r injury with a date f nset r date f injury. Insurance is lking fr smething that happened t cause the need fr rehabilitatin (restring functin t what it was befre the illness r injury). Sme insurance cmpanies cnsider the diagnsis f autism t meet criteria f medical necessity fr rehabilitatin services. If yu are insured by Aetna, it is ur experience that Aetna excludes benefits fr Neurdevelpmental therapy (Occupatinal, Physical and Speech Therapy thrugh 6 years f age) unless yur specific plan is under the Washingtn State mandate. Therefre, if yur child is 6 years r yunger, it is very imprtant that yu cntact Aetna prir t yur first appintment t cnfirm yur Neurdevelpmental therapy benefits. If yu live in Washingtn State please cnfirm that yur plan is under WA State Mandate and if utside f Washingtn please cnfirm yur therapy benefits and ask if yur child s diagnsis meets the criteria f medical necessity under shrt term rehabilitatin fr Occupatinal Therapy. Washingtn State clients: Washingtn State law mandates cverage by health care plans prvided by emplyers, health service cntractrs, health maintenance rganizatins and state emplyee health plans fr cvered individuals age 6 years and yunger fr Neurdevelpmental therapies (which include Occupatinal, Physical and Speech Therapy). If yur child is 6 years r yunger it is imprtant that yu ask yur insurance cmpany specifically abut eligibility and benefits fr Neurdevelpmental therapies and t verify if yur plan falls under Washingtn State Mandate. With sme exceptins, if yur child is 7 years r lder then yur accunt will be set-up as a private pay accunt. In mst cases we d nt submit claims t insurance fr children 7 years f age r ver. If yu chse t pay privately and submit claims t yur insurance fr cnsideratin f payment we will prvide yu with the claim frms. Based n ur experience, Micrsft is an exceptin t this rule and benefits fr Occupatinal Therapy cntinue after a child turns 7 years f age. It is ur understanding that Being Traditinal Plan has limited benefits fr children 7 years r lder 5

6 If yu have a change in medical insurance please ntify us with the effective date f cverage and the new billing infrmatin as sn as pssible. Cnfirm yur eligibility and benefits with yur new plan and request a new prescriptin frm yur physician that is written and dated n r after the effective date f yur new insurance cverage The cst f therapy services: The first fur evaluative treatment sessins are prvided t assess yur child and establish gals and a treatment plan fr therapy. When scheduled as part f weekly, nging therapy services the first fur evaluative treatment sessins are discunted t $140 per hur.(when evaluatins are prvided utside f nging therapy the fee is $220 per hur and we d nt accept insurance. ) When discunted evaluative treatment sessins are prvided then we request that the child cntinue with weekly therapy if recmmended by the therapist. The fee fr nn-evaluative Occupatinal Therapy sessins is $115 per hur If yu chse t pay at the time f the sessin r nce a mnth by credit card that is kept n file fr autmatic billing, then yu will receive a 10% cash discunt. (We d nt ffer a cash discunt n the first fur evaluative treatment sessins.) We will accept insurance fr nging therapy services (which includes the first fur ne-hur evaluative treatment sessins.) Hwever we rely n yu t keep yur accunt current, t make regular mnthly payments n yur accunt and t fllw up with yur insurance if yur claims are nt paid in a timely manner. We will submit claims t insurance fr payment. All f ur therapy services are billed as therapeutic activity (CPT 97530). If yu insurance requires a review f medical necessity and requests recrds t prcess claims, we are happy t send the recrds but depend n yu t fllw up n the status and t make regular payments until determinatin is make and insurance payments are received. Charges are psted t yur accunt n a mnthly basis, apprximately the middle f the fllwing mnth (i.e., January charges are psted mid-february and s n.) Insurance claims are submitted at the time that the charges are psted t yur accunt. Yu will receive yur first statement after yur initial claims have prcessed thrugh insurance and apprximately every 6 weeks thereafter. If yu have billing questins r cncerns please call r the ffice. We will respnd t yur billing cncerns prmptly. If yu reach ur vice mail, we will return yur call as quickly as pssible. 6

7 We have a standard 24-hur cancellatin plicy that requires ntificatin at least 24 hurs befre yur scheduled appintment in rder t avid being charged fr the missed appintment. Yu will be charged fr any cancellatins and/r missed appintments with less than 24-hur ntice prir t the missed appintment time The missed appintment charge is 50% f yur regularly hurly therapy rate and missed appintment charges cannt be billed t yur insurance. We will make exceptins fr illness and family emergencies. Please d nt the ffice with appintment cancellatins as yur therapist may nt receive an message as prmptly as a message by phne. If it is necessary t cancel an appintment please call the ffice directly (Seattle ffices call and Prtland ffice call ) If yu reach ur vice mail, please leave a message. Yur therapist will check fr messages thrughut the day and yur message shuld be received prmptly. We hpe this infrmatin is helpful. Please cntact us with any further questins. We lk frward t wrking with yu. The Offices f Rsemary White, OTR/L & Assciates Pediatric Physical and Occupatinal Therapy Services, Seattle WA 7