Starting Fresh without Starting Over- Refreshing Your Career to Gain New Opportunities

Reprinted from the NYTimes  April 2018 By Kerry Hannon
Two years ago I hosted a webinar for therapists over 50. Since that time I have been looking for different ways to support my over 50 colleagues ( myself included). One  easy way is to share information, and here for starters is a great article.

For Susan Golden, now 64, flinging on a backpack filled with books and rambling around the Stanford University campus in Palo Alto, Calif., for a year in 2016 was “like drinking from a fire hose,” she said. “There was so much to learn, so many classes and lectures I could attend.”

She graduated that year from the Stanford Distinguished Careers Institute, operated in partnership with the Stanford Center on Longevity. Each academic year 25 fellows, who have had two or three decades of a successful career, are selected to attend the program and to enroll in classes across the university.
Harvard’s Advanced Leadership Initiative, a yearlong program for corporate executives and professionals interested in applying their skills to social problems, operates with a similar concept. The program’s fellows (for 2018, 48 were selected from more than 550 applicants) get to audit courses at the university and its graduate schools and develop independent projects with professors and fellow students.

Rosabeth Moss Kanter, a Harvard Business School professor who is director of the leadership initiative, said the program was started “to deploy a new leadership force of people transitioning from their main career to their next years of service.”

Todd Fisher, 52, a fellow in Harvard’s program, was ready for a new challenge. He was a global chief administrative officer and partner of the private equity firm Kohlberg Kravis Roberts & Company and, he said, “I wanted to fundamentally shift my career.”

When Mr. Fisher turned 50, he heard about the program and started to make his plan. “I was nervous about finding my new career,” he said. “I’m the type of guy who wants to go get things done. I felt it would be valuable for me to be in a stimulating environment, where I had to develop different routines and to detox, or reprogram.”

This semester, Mr. Fisher is enrolled in a course on community colleges and another on leaders and leadership in history at the Harvard Kennedy School. His aim is to figure out his “next direction, to have a little bit of fun, make some new friends and to broaden my perspective and life,” he said. “I did not retire in the classic sense of the word. I do want to throw myself into something else: a true second career.”

In addition to the Stanford and Harvard programs, there are a handful of other educational programs for Gen Xers and baby boomers eyeing a second act.

Later this year, for example, the University of Notre Dame will start the Inspired Leadership Initiative, a one-year program for “accomplished leaders at the end of their careers.”

The University of Texas at Austin will also welcome later this year its first cadre for its nine-month Tower Fellows Program for those who “have built a career of major accomplishments (20 to 30 years) and who now seek to deepen their knowledge and/or embrace new fields.”



Don’t Use Infant Walkers

Reprinted from the NYTimes  – September 2018  N. Bakalar

More than 230,000 children younger than 15 months were treated in emergency rooms for injuries incurred while using infant walkers from 1990 to 2014.

An analysis published in Pediatrics has found that 6,539 of them had skull fractures, 91 percent of them from falling down stairs. The devices are banned in Canada, and the American Academy of Pediatrics recommends that they be banned in the United States as well.

The number of injuries went down in 1994 with the introduction of stationary activity centers — devices similar to walkers, but without wheels. Injuries declined again in the four years following the adoption of federal mandatory safety standards in 2010. Other factors may have been involved in the decrease as well, including declining infant walker sales, the number of them still in use, and product recalls.

“There are no advantages to using walkers,” said the senior author, Dr. Gary A. Smith, director of the Center for Injury Research and Policy at Nationwide Children’s Hospital in Columbus, Ohio. “They continue to have the potential for serious injury. Parents should be told not to use them.”

NYTPA is now an Approved ABA Provider in the Greater NY Area

Families living within 5 Boroughs of New York City, Long Island and Westchester can benefit from our team of Licensed Behavior Analysts (BCBA) and Behavior Therapists. We are ready to structure a program to address behavior goals, communication training and life skills essential for independence. Parents benefit from guidance and experience in the form of parent training and participation in the therapy. This program comes to you from an agency with 30 years of experience providing therapeutic and educational services across multiple modalities.

We make the process simple:
1.  Speak with our team and provide some basic information about your child.
2.  Once we verify insurance benefits, parents will need to provide proof of diagnosis and prescription for services.
3.  We will obtain authorization from the insurance carrier to assess, develop treatment plan and begin treatment.

We accept most major insurance plans including GHI, UHC, Fidelis Care, NYSHIP,  and Oxford. Our team is ready to help verify your benefits, eligibility and check whether you are covered. For some insurance carriers, the service can be provided at no cost.

If you’re a provider and know of a family or families who can benefit from this service, please feel free to pass along this information.  Please call our main office and inquire about ABA Therapy.

Don’t Count this NYC OT OuT- A New York Story with a Happy Ending!

When last we left veteran NYC Occupational Therapist Debra Fisher back in 2014, she had been suspended for 30 days without pay by the NYC Department of Education. Debra and others in the school where she worked had set up a Kickstarter fundraising drive aimed at helping a student on her caseload, Aaron Philip, put together a book and film to help other disabled kids — a project the school enthusiastically approved and supported.  In fact, the school participated in the campaign by sending out ongoing emails to the entire school community of both parents and staff.  Debra was none the less accused of “theft of services”, and the story was picked up by the major NY newspapers, including the NY Times and the Daily News.

By August 2015, NYC’s Special Commissioner of Investigation found  that an Education Department investigator made inaccurate statements and drew the wrong conclusions in his probe. In short, Debra’s “punishment” was rescinded by the DOE’s School Chancellor Carmen Farina.  Shortly there after, the publicity surrounding this story attracted the attention of the publishing house, Harper Collins, and this past February  This Kid Can Fly: It’s about Ability (NOT Disability) by Arron Philip was published. Written with award-winning author Tonya Bolden, This Kid Can Fly chronicles Aaron’s extraordinary journey from happy baby in Antigua to confident teen artist in New York City.

Aaron has since graduated  from PS 333, where Debra still works, but the two will be reunited on May 20, 2016.  Aaron, who currently attends the school at Blythdale Children’s Hospital following hip surgery returns to PS 333 for a special Town Hall Meeting where he will read from his book and sign copies. This great accomplishment will finally overshadow and put to rest the initial circumstances that brought this story into the public domain.

There could be no better validation for Debra. Along with others, she founded This Ability Not Disability (TAND), a non-profit organization that  works to find ways to support children, teens and young adults with significant physical disabilities develop the self-determination, self-advocacy and leadership skills to foster their own and everyone else’s belief that they can have a dream for their lives and work towards it like other youth. Its inaugural activity was supporting Aaron’s Kickstarter that allowed Aaron to work with artists and animators at the Children’s Museum of the Arts to create his first children’s book and video, TANDA.

This is why we do what we do.  Congratulations to Debra for her longstanding service to the children of New York, and her fortitude and spirit in demonstrating all that is great in Occupational Therapy. There is no doubt that she and Aaron will continue to inspire many of us for years to come.

Check out this fantastic video about the book and its author 


“As we acquire new and more technical skills, we begin to devalue what we had before we started: understanding, empathy, imagination.”

Reprinted from the NYTimes – 4.12.2016 Written by on a Friday night. Dhruv Khullar, M.D., M.P.P. is a resident physician at Massachusetts General Hospital and Harvard Medical School.

Too good and spot on not to share – this gentle and beautifully written reminder for everyone in the healthcare field!

Friday night in the emergency department is about what you’d think. It starts off slow: a middle-aged man with a middling pneumonia; an older nursing home resident with a urinary tract infection that is making her delirious. Then come two heart attacks at the same time, followed by a drunken driver with a head bleed and half his rib cage fractured. At midnight, in roll the inebriated members of a bachelorette party that has not gone, one assumes, according to plan.

Amid the chaos, I break off to greet a thin, older man, quietly bundled up on a hallway stretcher. I look over his chart and prior scans. His prostate cancer has grown through several chemotherapy regimens. His spine is full of tumor and he’s been vomiting everything he eats or drinks for weeks. He can’t move the left side of his body after a recent stroke.

He smiles a charming, crooked smile. “It hasn’t been the best month of my life.”

“I’m sorry to hear that.”

I ask him about his symptoms, when they started, how bad they’ve gotten. He asks me where I went to medical school and if I have a girlfriend. I ask him if he’s dizzy and whether there’s blood in his stool. He tells me he emigrated from Greece 50 years ago, almost to the day. He won a scholarship to M.I.T. and studied electrical engineering. There he met his wife — “a fantastic cook” — and started his first company.

Now, decades later, he’s alone — in a crowded emergency room, on a Friday night, his wife dead, his two sons overseas, a nurse visiting him once a week at home to help him with some medicines and make sure the various tubes coming out of his body aren’t infected.

I ask him when he last moved his bowels. “Son, I’m dying. I’m alone. One day you’ll learn there’s more to a good death than how often I move my bowels.” I pause.

I am better at many things than I was when I started my journey to become a physician more than a decade ago. But I am not sure that understanding patients as people — and placing them in the context of their long, messy, beautiful lives — is one of them.

Doctors are trained first to diagnose, treat and fix — and second, to comfort, palliate and soothe. The result is a slow loss of vision, an inability to see who and what people are outside the patient we see in the hospital.

As we acquire new and more technical skills, we begin to devalue what we had before we started: understanding, empathy, imagination. We see patients dressed in hospital gowns and non-skid socks — not jeans and baseball caps — and train our eyes to see asymmetries, rashes and blood vessels, while un-training them to see insecurities, joys and frustrations. As big data, consensus statements and treatment algorithms pervade medicine, small gestures of kindness and spontaneity — the caregiving equivalents of holding open doors and pulling out chairs — fall by the wayside.

But all care is ultimately delivered at the level of an individual. And while we might learn more about a particular patient’s preferences or tolerance for risk while explaining the pros and cons of a specific procedure or test, a more robust, more holistic understanding requires a deeper appreciation of “Who is this person I’m speaking with?”

In Britain, a small but growing body of research has found that allowing patients to tell their life stories has benefits for both patients and caregivers. Research — focused mostly on older patients and other residents of long-term care facilities — suggests that providing a biographical account of one’s past can help patients gain insight into their current needs and priorities, and allow doctors to develop closer relationships with patients by more clearly seeing “the person behind the patient.”

In the United States, Medicare recently began paying doctors to talk with their patients about end-of-life planning. These conversations allow patients to discuss and explore their preferences about a slew of complex medical interventions, including clinical trials, transfers to the intensive care unit, use of mechanical ventilation or feeding tubes, and the desire to die at home or in the hospital. These discussions, too, may benefit from a biographical approach, in which patients are able to elaborate on what is and has been most important in their lives. To better serve patients, we need to see not only who they are, but also who they were, and ultimately, who they hope to become even at the end of life.

How much more effective would we be as diagnosticians, prognosticators and healers if we had a more longitudinal understanding of the patient in front of us? If we saw not just the shrunken, elderly Greek man on the emergency room stretcher in front of us, but also the proud teenager flying across the Atlantic to start a new life half a century ago?

The emergency room is, by its nature, an arena designed for quick thinking and swift action. There are certainly other places, times and circumstances more conducive to probing goals-of-care discussions and lengthy forays into the internal lives of patients.

Still, there is always some moment of grace and meaning we can help patients find in the time they have left, a moment that recalls a time when they felt most alive — even if it’s just a fleeting conversation about gyros and electrical circuits in a busy emergency room, late on a Friday night.

An Occupational Therapist to Admirer – 91 y.o Barbara Knickerbocker- Beskind

“When I got married at the age of 52 my private practice flourished, because we built a separate building that housed my then-husband’s practice of psychotherapy on one side and my OT practice on the other. In 1984 we moved from New Jersey to Vermont and I was a consultant for the school system there.I tried to retire five times – as an OT, as a private practitioner, as an author – but it never works. I went back to school to become an artist in 1997 and that has been helpful in drawing my inventions.

In 2013, I saw David Kelley – the founder of the design firm IDEO – on the TV programme 60 minutes. When I realised he accepted, and really respected, people from a varied background, I thought, “I have a unique kind of life experience and designing skills – I could be of value to their firm.” I was 89.I typed a letter, which might have caught their attention because they don’t get many communications by “snail mail”- I have macular degeneration so my eyesight prevents me from using computers.”

Read more at:



New Legislation Passed in NYS on Telehealth and OTAs!!!

(1) NYS has become the latest and last state to require licensure for OTAs!

(2) The OT/PT telehealth parity bill was also signed into law. The law states that deductibles, co-insurance or other conditions for coverage of telemedicine cannot differ from those for in-person visits. It also differentiates between telemedicine and telehealth. Telemedicine, it says, refers to real time, two-way electronic audiovisual communications, while telehealth can include telephones calls, remote patient monitoring devices or other electronic means of diagnosis, consultation, education and treatment.

Table of Contents for Policy and Procedure Manual


1.  Initial Intake Form – Generic for Adults and Specific to Pediatrics
2.  Generic Evaluation Forms  (Pediatric and Adult Practices)
3.  Generic Progress Re-evaluation Note
4.  Generic Discharge Form
5.  Assignment of Benefits Form/Patient Notification of Billing/Cancellation/Discontinuance of Services Policy/Financial Policy Form
6.  Medicare Beneficiary Form
7.  Authorization for Release of Confidential Information
8.  Notice of Patient Privacy Practice/ Patient Information Consent Form
9.  Patient Satisfaction Survey
10.  Referral Source Satisfaction Survey
11.  Photo/Video Release Form / Waiver Form for Onsite Classes/Permission Slip for Caregivers
1.  Incident Reporting and Form
2.  Child Abuse
3.  Confidentiality, Release and Handling of Information including HIV Information
4.  Confidentiality for Emails/Faxes
5.  Emergency Preparedness Plan
6.  Health and Safety Issues Including Universal Precautions, Infection Control/   Handwashing Procedures
7.  HIPAA Policy and Procedures –
8.  Rehabilitation Update/Documentation for Medicare Patients
9.  Clinical Chart Review Form

1.  Application Form, Orientation and Minimum Requirements of Therapists
2.  Reference Forms
3.  Clinical Competency Review Form
4.  Employee Health Assessment
5.  Hepatitis B Consent/Decline Form
6.  Freedom from Impairment Form
7.  On Site Clinical Competency Form
8.  Sample Employee Handbook
9.   Code of Ethics  – OT, PT ST
1o. Job Descriptions – clinical and non clinical –

1. Sample Temporary Personnel Services Agreement
2. Sample Home Care Personnel Services Agreement
3.  Sample Contract for School District Service Provision
4.  Sample Independent Contractor Agreement
5.  Sample Employee Contract

PLUS – New for 2018 – forms for pre payment and prompt payment discounts, medical hardshipconsent for treatment

Purchase now:  $160 for downloadable, editable word document you can edit and customize with your practice name etc.

The Art of Communication – Easier Said Than Done ( no pun intended)

Good communication is at the heart of patient safety, cultural sensitivity, and the pillar of quality care.  Most of the time we focus on the message we are communicating, and how best to choose  words that adequately communicate the message we are trying to convey, while using language that the patient and family fully understand.  Yet, as pointed out in a great NY Times Op Ed Piece this week  (Doctor Shut up and Listen by Nitmal Joshi ), we need to focus equally on the other side of the communication equation, listening.

The core skill of good communication is listening. Listening requires that we put aside any thoughts of what we want to say next and just attend to the person talking. It requires that we be curious enough and interested enough in the other person to make sure we are clear about what they are saying, asking for clarification and reflecting back to make sure we have heard correctly. It is about taking seriously that the conversation is not about us but about the other.

Good listening is about understanding that good listening is often enough. Do patients want an answer to a question or do they just want me  — as the therapist — to listen to them? They want to be heard and, through that hearing, respected. Do they want my words or do they want my attention and presence? Even when the patient is looking for an answer, listening and creating a space for the patient to reflect may be all they need to come to the answer themselves rather than having me impose it on them.

 Don’t minimize listening by saying we “just” listened. This so simple but so powerful that often it is one of the best interventions we can make with our patients and their families.


Having certain Medicare claims re-opened without the appeal process!

Medicare Claim Re-openings and How to Request a Reopening

In the case where a minor error or omission of your Medicare claim submission resulted in a claim denial, you can request Medicare to reopen the claim so the error or omission can be corrected, rather than having to go through the appeal process. There is no need to request an appeal/redetermination if you have made a minor error or omission in filing the claim, which, in turn, caused the claim to be denied. You can request a reopening for minor errors or omissions either by telephone, in writing or via NGSConnex. You have one year to request a reopening from the date on your RA.

The clerical error reopening process is not a part of the formal appeals process, but it allows providers to make a minor change to a previously filed claim, if the original claim has been denied or reduced. CMS provides the instructions for reopening activities conducted by MACs. Section 937 of the MMA required CMS to establish a process whereby providers, physicians, and suppliers could correct minor errors or omissions outside of the appeals process.

Clerical error reopenings can be done on the phone, in writing or via NGSConnex, for providers to correct minor errors, clerical errors, or omissions. The MAC reserves the right to refuse to adjust a claim as requested if it appears that such an adjustment would risk incorrect payment on any claims not identified for correction.

A provider, physician, or supplier may request a reopening up to one year from the receipt of the initial remittance notice. If the provider, physician, or supplier would like to request a reopening after the one-year time limit has expired, they may request the reopening in writing. Documentation supporting good cause to waive the timeliness requirement must be included.

CMS issued interim final regulations, which state clerical errors (which CMS likens to MMA’s minor errors or omissions), are defined as human or mechanical errors on the part of the party or the contractor, such as:

  • Mathematical or computational mistakes;
  • Transposed procedure or diagnostic codes;
  • Inaccurate data entry;
  • Misapplication of a fee schedule;
  • Computer error; or,
  • Denial of claims as duplicates which are denied as a result of a clerical error or minor omission and require a change on the face of the claim (i.e., adding or removing a modifier) in order for the claim to be reopened. (Exception: We will reopen claims that denied as a duplicate when multiple services have been billed and some are denied due to a separate claim submission; i.e., when three radiology services have been paid on one claim and a fourth one denied as a duplicate due to a separate claim submission and a request is made to allow a total of four services. A reopening can be performed even though the claim was submitted correctly and no change is being made.)
  • Incorrect data items, such as provider number, use of a modifier or date of service.

The basis of a clerical error or minor omission reopening is to correct the minor clerical or minor omission that resulted in an initial claim denial or reduction.

Types of Issues that can be performed as clerical error or minor omission reopenings:

  • Increase number of services or units (without an increase in the billed amount)
  • Add/change/delete modifiers such as 24, 25, 54, 57, 58, 59, 76, 77, 78, 79, 80, AS, or AQ (Note: Postoperative modifiers 24, 25, 57 and 58 can be added to a paid claim so the provider can submit a procedure code without having it reduced by the unrelated visit.)
  • Procedure codes
  • Place of service
  • Add or change a diagnosis on a denied service
  • Billed amounts
  • Incorrect provider number to deny
  • Incorrect HIC to deny
  • MSP unrelated – non-GHP records
  • Correcting rendering provider PTAN/NPI
  • Addition of referring provider PTAN/NPI
  • Add date last seen on the claim
  • Date of service – the date of service change must be within the same year
  • Services billed in error
  • Refunds (except 935 refunds)

Types of Issues that cannot be performed as clerical error or minor omission reopenings. For these issues providers must submit a redetermination request in writing:

  • Comprehensive Error Rate Testing (CERT)
  • Provider enrollment issues
  • Claim denial due to no response to a development request
  • Established Recovery Auditor (RA) overpayment (Telephone only)
  • Services with a high dollar amount ($7,500 or more)
  • Wrong payee
  • Complex claim situations (such as ambulance, anesthesia, Not Otherwise Classified codes, claims with modifiers 22, 23, 53, 62, 66, GA or GY or any other claim which requires analysis of documentation).
  • CMS input (e.g. services after date of death)
  • If there are multiple surgeries on multiple claims for the date of service in question

Some situations would not be appropriate for the reopening or redetermination process:

  • If the original denial is rejected as unprocessable, submit a new claim
  • If the claim in question is in process, you must wait until after the claim has processed before requesting a reopening
  • If there has been no claim submitted, submit a new claim
Level/Type Time Limit Amount in Controversy
Required (after deductible and coinsurance)
Telephone Reopening Within 1 year of receipt of the notice of initial determination. No minimum
Written Reopening Within 1 year of receipt of the notice of initial determination and within 4 years after the date of the initial determination, when the situation establishes good cause. No minimum

Telephone Reopenings

Providers may request a reopening of the original claims processing decision by contacting the Appeals Telephone Reopening Unit (TRU).

The TRU can be used when you wish to revise the initial determination or redetermination of a specific service or claim for minor clerical errors. If you have a general question or need to talk to someone about an issue that cannot be reopened, please contact our Provider Contact Center.

TRU representatives will reopen claims to correct minor, uncomplicated, provider or contractor clerical errors or omissions. However, TRU representatives cannot add items or services that were not previously billed. Please Note: Reopenings are granted at the contractor’s discretion; a claim may not be appealed if contractor decides not reopen the claim.

With the availability of the electronic remittance advice you can know the outcome prior to the complete finalization of a claim. Please ensure the claim has finalized prior to calling the TRU line to request changes to the claim.

Note: Unsolicited faxes will be returned to the sender unprocessed.

Using NGSConnex to Submit a Redetermination or Reopening Request

NGSConnex, a free and secure web-based application, has a convenient option available that providers can use to submit an appeal request for a claim redetermination or reopening online instead of submitting a paper appeal. Providers can also check the status of redeterminations/reopening requests.

For complete instructions on using NGSConnex for submitting a reopening request, visit our Reopenings for Minor Errors and Omissions section of our website.

Written Reopening Requests

Jurisdiction 6 providers in Illinois, Minnesota and Wisconsin should mail written reopening requests to:

National Government Services, Inc.
P.O. Box 6475
Indianapolis, IN 46206-6475

Jurisdiction K providers in Connecticut, Maine, Massachusetts, New Hampshire, New York, Rhode Island and Vermont should mail written reopening requests to:

National Government Services, Inc.
P.O. Box 7111
Indianapolis, IN 46207-7111

Be sure to include the following information with your reopening request:

  • The beneficiary’s name
  • The Medicare HICN of the beneficiary
  • The specific services(s) and/or item(s) for which the reopening is being requested and the specific date(s) of service, and
  • The name and signature of the person filing the request

Reopening requests for issues requiring documentation such as adding modifier 22 and redetermination of overpayments are not permitted. These must be submitted as a written redetermination request.
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