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of conduct, practice standard or scope of practice, or represent healthcare fran

ID: 242047 • Letter: O

Question

of conduct, practice standard or scope of practice, or represent healthcare frand or abuse?). Case Study: Substance Abuse Counselor Treatment Jim, a substance abuse counselor with a license in social work, had a private practice in a rural county in Michigan. He was appropriately licensed as a social worker and he was properly credentialed with Medicare. He was successful in obtaining a Medicare provider "pin" number so that he could see patients with this type of health insurance coverage. 1. Jim employed a WMU graduate who was planning on obtaining his license in social work but had not taken the examination yet. Since the WMU graduate was properly trained, Jim decided to allow the graduate to bill Medicare using his provider identification aumber. Jim did not provide any supervision to the graduate or sign off on his clinical documentation. What did Jim possibly do wrong? Case Study: Occupational Therapy Treatment An occupational therapist at the WMU Outpatient Clinic received a referral of an elderly individual with a developmental disability who used a wheelchair. This individual could benefit from treatment (range of motion, weight bearing exercises, etc.) to maintain physical capacity to perform activities of daily living Since Medicare will not pay for maintenance of function, but they will pay for retraining, the therapist evaluated the patient and documented that the patient needed re-education for adult daily living (ADL) 2. Did the occupational therapist do anything wrong? What?

Explanation / Answer

Must not bill to Medicare since he don’t have licenses this fraud in Medical billing he doesn’t have credential bill this service if have a supervising Physician we bill under supervising physician NPI or the below list of health care providers

Licensed clinical social worker (LCSW)

• A person holding a masters degree in social work (MSW), marital and family therapy or mental health counseling , except that partial hospitalization services provided by such person shall not be reimburse

• Licensed psychologist

• Licensed independent practice school psychologist Licensed independent practice school psychologist

• Licensed marriage and family therapist (LMFT)

• Licensed mental health counselor (LMHC)

• An Advanced practice nurse who is a licensed registered nurse with a master An Advanced practice nurse who is a licensed, registered nurse with a master s’ degree in nursing with a major in psychiatric and mental health nursing from an accredited school of nursing

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