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Practice Policies:  Page Under Construction 10/2/2023

Fees and Expenses:

​1. Initial Evaluation - The charge for this is determined based on the level of complexity of a client's individual needs. Three levels of evaluation offered are standard, expanded and comprehensive evaluations. Determination of the level of an evaluation is based upon CPT occupational therapy evaluation code criteria. 2. Time sensitive direct therapy services - These can include such services as therapeutic activities, therapeutic procedures and therapeutic interventions. Charges for these services are based on one-to-one treatment time and are billed in 15-minute increments. 3. Re-Evaluation - This service may be necessary if services occur over an extended period, or when a significant change occurs 4. Targeted Testing - This service may be indicated when in-depth evaluation is necessary for a specific area of concern after the initial evaluation visit. Fees are dependent upon the type of testing provided per CPT billing code criteria 5. Meeting Attendance - your child's therapist can participate in meetings outside of schedule therapy sessions at your request, subject to availability. This service is not considered "skilled occupational therapy" and cannot be billed to insurance providers. Meeting attendance will be billed directly to the parent/ caregiver at a rate of $85/ hour including preparation and travel time. (prorated in 15 minute increments). 6. Parent Collaboration - Phone or teleconferencing with parents that occur outside of schedule sessions and last more than 15 minutes will be billed to the parent/caregiver at a rate of $50/hour (prorated in 15 minute increments). Fees are reviewed on an annual basis, and Nashoba Pediatric Therapies reserves the right to adjust the fees when it is deemed necessary. Thirty-day advanced written notification will be provided if any fee increase is instituted. A copy of our current fee schedule can be provided via email or US Mail upon request. BILLING FOR SERVICES RENDERED All bills for services rendered will be sent out to the insurance carrier within thirty days of the service performed. Any co-payment, co-insurance, or deductible is due at the time of service. For patients paying out of pocket, payment is expected at the time of service unless other arrangements have been made. All invoices unpaid after 45 days will be subject to the maximum interest penalty/finance charge allowed by law. Nashoba Pediatric Therapies reserves the right to cancel treatment if payment for services is not received, and to use whatever means necessary including an attorney, small claims court, or collection agency in an attempt to secure payment

Attendance, Cancellation and No- Show Policies

To be respectful of all party's time and in consideration of others awaiting services, Nashoba Pediatric Therapies employs an attendance policy for all scheduled therapy appointments. It is as follows: *CANCELLATION DUE TO ILLNESS: It is important that all parties be respectful of health concerns. Children with diarrhea, vomiting, contagious diseases, and/or a temperature above 100F should not be seen for therapy. Should your child (or another child in the home who may engage in therapy sessions) wake up with any of these symptoms, please contact Nashoba Pediatric Therapies as soon as possible. Your child should be symptom free for 24 hours before resuming therapy. If cancelling due to illness less than 24 hours before the appointment, you will be encouraged to request to reschedule the visit within a 2-week period to allow the late cancellation fee to be waived (see below). *LATE CANCELLATION NOTICE: We request that expected cancellations be communicated to Nashoba Pediatric Therapies with as much advanced notice as possible to allow us to fill the open time slot. Cancellations made less than 24 hours before a scheduled appointment will be subject to a $30 cancellation fee. This fee will be charged to the credit card on file. If the visit is able to be rescheduled within a 2-week period, this fee will be waived. *"No-Shows": In the event of a "no call/ no show", regardless of the reason, you will be charged fee of $50. Two "no-shows" within a 3-month timeframe will result in the child being discharged from active service. *CONSISTENT ATTENDANCE: In order to benefit from therapy services, consistent attendance is essential. If a client / family is demonstrating difficulty keeping scheduled appointments (due to any reason including illness, weather, family emergencies, etc.) a written notice will be provided, and attempts will be made to work with you to improve consistency. If consistency challenges continue following this intervention, then you child's appointment time may be forfeited or therapy services will be discontinued. **CONSISTENT ATTENDANCE IS DEFINED AS ATTENDANCE AT 75% OF SCHEDULED APPOINTMENTS OR GREATER OVER A 4-WEEK PERIOD

No Surprises Act

Under the No Surprises Act Under Section 2799B-6 of the Public Health Service Act, health care providers and health care facilities are required to inform individuals who are NOT enrolled in a plan or coverage or a Federal health care program, or NOT seeking to file a claim with their plan or coverage both orally and in writing of their ability, upon request or at the time of scheduling health care items and services,
​to receive a “Good Faith Estimate” of expected charges.

You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost. Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services.

• You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.

• Make sure your health care provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item. You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.

• If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.

• Make sure to save a copy or picture of your Good Faith Estimate.

For questions or more information about your right to a Good Faith Estimate, visit or use my contact form to reach me

Notice of Privacy Practices

Notice of Privacy Practices - (reviewed Aug, 2023) Name of Practice: Nashoba Pediatric Therapies, LLC THIS NOTICE DESCRIBES HOW HEALTH INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY. I. MY PLEDGE TO YOU REGARDING HEALTH INFORMATION: I understand that health information about your child and his/her health care is personal. I am committed to protecting health information about your child. I create a record of health care and services provided by me. I need this record to provide quality care and to comply with certain legal requirements. This Notice applies to all of the records of you child's care generated by this occupational therapy practice. This Notice will tell you about the ways in which I may use and disclose health information about your child. I also describe your rights to the health information I keep and about your child, and describe certain obligations I have regarding the use and disclosure of your child's health information. I am required by law to: Make sure that protected health information ("PHI") that identifies your child is kept private Give you this Notice of my legal duties and privacy practices with respect to health information Follow the terms of the notice that are currently in effect I can change the terms of this Notice, and such changes will apply to all information I have about your child. The new Notice        will be available upon request and can be provided electronically or via US Mail, or accessed on my website II. HOW I MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOUR CHILD: The following categories describe different ways that I use and disclose health information. For each category of uses or disclosures I will explain what I mean and try to give examples. Not every use or disclosure in a category will be listed. However, all of the ways I am permitted to use and disclose information will fall within one of the categories. For Treatment Payment, or Health Care Operations: Federal privacy rules and regulations allow health care providers who have direct treatment relationships with the client to use or disclose the client's personal health information without the client's written authorization, to carry out the health care provider's own treatment, payment or health care operations. I may also disclose your protected health information for the treatment activities of any health care provider. This too can be done without your written authorization. For example, if a therapist were to consult with another licensed health care provider about your child's condition, we would be permitted to use and disclose personal health information, which is otherwise confidential, in order to assist the therapist in diagnosis and treatment of your child's functional difficulties. Disclosures for treatment purposes are not limited to the minimum necessary standard. Because therapies and other health care providers need access to the full record and/or full and complete information in order to provide quality care. The word "treatment" includes, among other things, the coordination and management of health care providers with a third party, consultations between health care providers and referrals of a patient for health care from one health care provider to another. Lawsuits and Disputes: If you and/or your child is involved in a lawsuit, I may disclose health information in response to a court or administrative order. I may also disclose health information about your child in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested. III. CERTAIN USES AND DISCLOSURES REQUIRE YOUR AUTHORIZATION: 1) Nashoba Pediatric Therapies, LLC keeps documentation of each treatment encounter, and any use or disclosure of such documentation requires your authorization unless the use of disclosure is: For my use in treating you child For my use in training or supervising occupational therapy practitioners to help them improve their skills in therapeutic        evaluation and intervention For my use in defending myself in legal proceedings instituted by you or another person acting on your child's behalf For use by the Secretary of Health and Human Services to investigate my compliance with HIPAA Required by law and the use or disclosure is limited to the requirements of such law Required by law for certain health oversight activities pertaining to the originator of the occupational therapy documentation Required by a coroner who is performing duties authorized by law Required to help avert a serious threat to the health and safety of others 2) Marketing Purpose. As an occupational therapist, I will not use or disclose your child's PHI for marketing purpose 3) Sale of PHI. As an occupational therapist, I will not sell your child's PHI in the regular course of my business IV. CERTAIN USES AND DISCLOSURES DO NOT REQUIRE YOUR AUTHORIZATION. Subject to certain limitations of the law, I can use and disclose your child's PHI without your authorization for the following reasons: When disclosure is required by state or federal law, and the use or disclosure complies with and is limited to the relevant        requirements of such law For public health activities, including reporting suspected child, elder, or dependent adult abuse, or preventing or reducing a        serious threat to anyone's health or safety For health oversight activities, including audits and investigations For judicial and administrative proceedings, including responding to a court or administrative order, although my preference        is to obtain an authorization from you before doing so For law enforcement purposes, including reporting crimes occurring on my premises To coroners or medical examiners, when such individuals are performing duties authorized by law For research purposes, including studying and comparing the functional abilities of clients who received one form of therapy        versus those who received another form of therapy for the same condition Specialized government functions, including, ensuring the proper execution of military missions; or, helping to ensure the        safety of those working within or housed in correctional institutions For worker's compensation purposes. Although my preference is to obtain an authorization from you, I may provide your        child's PHI in order to comply with worker's compensation laws Appointment reminders and health related benefits or services. I may use and disclose your child's PHI to contact you to       remind you that your child has an appointment with me. I may also use and disclose your PHI to tell you about treatment       alternatives, or other health care services or benefits that I offer V. CERTAIN USES AND DISCLOSURES REQUIRE YOU TO HAVE THE OPPORTUNITY TO OBJECT: Disclosures to family, friends, or others. I may provide you child's PHI to a family member, friend, or other person that you indicate is involved in your child's care or the payment for you child's health care, unless you object in whole or part. The opportunity to consent may be obtained retroactively in emergency situations VI. YOU HAVE THE FOLLOWING RIGHTS WITH RESPECT TO YOUR PHI: The Right to Request Limits on Uses and Disclosures of Your Child's PHI. You have the right to ask me not to use or disclose certain PHI for treatment, payment, or health care operations purposes. I am not required to agree to your request, and I may say "no" if I believe it would affect your child's health care. The Right to Request Restrictions for Out-Of-Pocket Expenses Paid for in Full. You have the right to request restrictions on disclosures of your child's PHI to health plans for payment or health care operations purposes if the PHI pertains solely to a health care item or a health care service that you have paid for out-of-pocket in full The Right to Choose How I send PHI to You and Your Child. You have the right to ask me to contact you in a specific way (for example, home or office phone) or to send mail to a different address, and I will agree to all reasonable requests The Right to Get Copies of your Child's PHI. You have the right to ask me to get an electronic or paper copy of your child's medical record, or a summary of it, if you agree to a summary, within 30 days of receiving your written request, and I may charge you a reasonable, cost based fee for doing so The Right To Get a List of the Disclosures I Have Made. You have the right to request a list of instances in which I have disclosed your child's PHI for purposes other than treatment, payment, or health care operations, or for which you provided me with an authorization. I will respond to your request for an accounting of disclosures within 60 days of receiving your request. The list I will give you will include disclosures made in the last 6 years unless you request a shorter time. I will provide the list to you at no charge, but if you make more than one requesting the same year, I will charge you a reasonable cost based fee for each additional request The Right to Correct or Update Your Child's PHI. If you believe that there is a mistake in your child's PHI, or that a piece of important information is missing from your child's PHI, you have the right to request that I correct the existing information or add the missing information. I may say "no" to your request, but I will tell you why in writing within 60 days of receiving your request The Right to Get a Paper or Electronic Copy of this Notice. You have the right to get a paper copy of this notice, and you have the right to get a copy of this notice by e-mail. And, even if you have agreed to receive this notice via email, you also have the right to request a paper copy of it

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