Outpatient Physical Therapy Management of Cardiovascular Disease

1. Overview of Cardiac Rehabilitation (CR)

This chapter covers the definition and purpose of cardiac rehabilitation. Program requirements, appropriate diagnoses, and contraindications for therapy are also discussed. Clinicians will learn how to stratify their patients’ risk to be able to apply interventions safely and effectively in the clinic.

2. Medicare Requirements for Cardiac Rehabilitation

This chapter will discuss the Medicare requirements for cardiac rehabilitation, including physician-prescribed exercise, risk factor modification, psychosocial assessments, outcome assessments, individualized treatment plans, and setting requirements. This is an important chapter as anyone setting up a cardiac rehabilitation program must follow Medicare guidelines in order to be reimbursed and not raise flags for an audit.

3. Staffing in Cardiac Rehabilitation

This chapter describes the typical staff seen in cardiac rehabilitation clinics, including the medical director. We will discuss the core competencies required for physical therapists and the role of PT assistants in outpatient cardiac rehabilitation. For clinics wishing to start a program, this is important logistical information to ensure proper staffing for reimbursement.

4. Examples of Program Structure

This chapter will provide the typical cardiac rehabilitation program structure as well as examples of existing cardiac rehabilitation programs. Typical equipment used in cardiac rehabilitation will also be provided. Individuals starting cardiac rehabilitation programs benefit when they have a model to use to develop their program.

5. Billing and Logistics in Cardiac Rehabilitation

This chapter will cover the Medicare billing codes and requirements and discuss possible patient co-payment. Billing requirements for Medicare Advantage, private-pay insurance, and Medicaid will also be discussed. Options for billing codes for patients in need of cardiac rehabilitation services who do not meet Medicare requirements will be presented. We will also talk about telehealth and home health options for patients who cannot attend a center-based program. This is important for clinics to ensure reimbursement for services.

6. Frequently Asked Questions and Answers

Five to eight questions will be presented, along with answers to these questions. These questions come from clinicians who have asked for assistance in developing and structuring their programs and will help others who are in the development or restructuring phase of their cardiac rehabilitation programs.