Professional- licensure, reimbursement, other

Hi everyone,

I’m currently working in a subacute care facility that provides skilled PT, OT, and nursing services — but we don’t have a formal cardiac rehab program in place. A cardiologist is interested in referring patients for clinical exercise physiologist who are in long term care and we’re trying to figure out how that might work within our current setup.

Our DOR asked what kind of documentation would need to be done under therapy services (PT/OT) to ensure it’s billable, especially since we don’t have CEP or cardiac rehab-specific billing in place.

Has anyone dealt with something similar? Would love to hear how you handled documentation, billing, and integrating exercise physiologist into a SNF or subacute setting.

Thanks in advance!

Clinical Exercise Physiology is still not billable through a SNF. However, I worked for a company for 9 years that hired Exercise Physiologists alongside PTs and OTs in ILFs and ALFs. It's called Fox Rehabilitation and it's primarily located across 28 states from the east headed to Midwest. Before Covid they employed over 75 EPs across over 20 states. Now I do not know how many they have. The EPs were assigned to ALFs to run the Fall risk reduction programs for residents. We conducted fall risk testing, ie 30 sec chair rise, TUG, etc. Referred residents to PT and OT according to fall risk. Once finished with therapy they woukd be referred back to EP and either work with me one on one or join our senior fall risk reduction Exercise class. One on one was self pay. But I had no problem getting patients. At one point I was seeing 25 patients a week. It's a great concept and you can look it up as there are some research studies conducted and available on PubMed. But nothing specific for Cardiac Rehab.

I recommend a great new publication that you may find helpful Billing for Exercise Is Medicine: An Analysis of Reimbursement Trends for Physical Activity–Related Billing Codes

in Journal of Physical Activity and Health