RE: Re: Part A PPS billing update

[Guest guest]

I have attached the link below to the CMS Transmittal that discusses this

clarification. Keep in mind that under SNF Part A stays, providers do not get

reimbursed via CPT codes. They are reimbursed via RUG categories.

http://www.cms.gov/transmittals/downloads/R2183CP.pdf

Rick Gawenda, PT

President

Gawenda Seminars & Consulting, Inc

www.gawendaseminars.com

Subject: RE: Re: Part A PPS billing update

To: " PTManager Group " <ptmanager >

Date: Monday, April 4, 2011, 3:29 PM

 

Kathy

The quote from the MLN newsletter is:

Coding PPS Bills for Ancillary Services

For therapy services (revenue codes 042x, 043x, and 044x), units represent the

number of sessions of therapy provided. For example, if the beneficiary received

therapy for a total of 52 minutes (25 minutes concurrently and 27 minutes

individually) in one session the units billed would be 1.

What is being referred to here is number of sessions of therapy provided. It is

not referring to the units for CPT/HCPC procedure codes associated with a fee.

When billing you must indicate the number of sessions performed as well as

converting the minutes of treatment performed into the appropriate service units

of timed and un-timed CPT codes. What this article is clarifying is that just

because you are doing different kinds of treatment (Individual/Concurrent) does

not mean that you would bill it as two separate sessions. Only one treatment

will be billed in this case.

Some facilities choose not to bill Part A therapy by CPT code. To simplify their

billing they bill all treatment by a single code per discipline. In these cases

the units of service may be for the same code regardless of what procedure was

actually done for that treatment session.

We will continue to bill for service units but only one session is billed even

when more that one procedure or type of treatment is delivered.

Ron Wall

Axiom Healthcare Group

Ontario, CA

To: PTManager

From: ksawa@...

Date: Mon, 4 Apr 2011 16:29:32 +0000

Subject: Re: Part A PPS billing update

I received the information in a MLN (Medicare Learning Network) Matters

newsletter number MM7339 dated 3/25/11.

Kathy Sawa, MPT

Neilson Place

Bemidji, MN

>

> I would like to know how to get to that link.

>

>

>

> Pamela J. Harbert, LPTA

>

> Director of Therapy Services

>

> Henry County Health and Rehab

>

> Abbeville, AL

>

> " Excellence is not a skill. It is an attitude. "

>

>

>

>

>

> From: PTManager [mailto:PTManager ] On Behalf

> Of kathysawa

> Sent: Thursday, March 31, 2011 10:50 AM

> To: PTManager

> Subject: Part A PPS billing update

>

>

>

>

>

> Hello group,

> I work in a SNF setting. I just received a notification from CMS regarding

> billing of units when a patient has both concurrent and individual minutes

> in a day. According to the notification, I could only bill 1 unit for the

> day regardless of the number of minutes provided. The example from CMS has a

> patient receiving 52 minutes of therapy (25 concurrent minutes and 27

> individual minutes) and CMS states that 1 unit would be billed. Am I

> interpreting this correctly?

>

> Kathy Sawa, MPT

> Neilson Place

> Bemidji, MN

>

>

>

>

>

>