RE: Re: Medicare billing question

[Guest guest]

I do think it depends on your MAC. We are an ORF and we bill weekly;

however, our MAC will allow daily billing.

________________________________

From: PTManager [mailto:PTManager ] On

Behalf Of

Sent: Monday, June 13, 2011 7:25 AM

To: PTManager

Subject: Re: Medicare billing question

Monthly or at discharge:

p. 145

http://www.cms.gov/manuals/downloads/clm104c01.pdf

Aldridge

Vitalis Medical Billing

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> Depends on your MAC, but I can tell you that you SHOULD be able to

bill daily. The difference between an ORF and a PTIPP (outpatient rehab

facility and physical therapist in private practice) is that an ORF

bills on a UB04 and the other on a HCFA (or an ANSI 837I-Instititutional

vs and 837P-Professional electronic claim). Historically if you billed

on the UB04, the Intermediaries wanted you to bill a month of service as

a self contained claim. However, times have changed and MAC's do permit

daily billing. If you would like to discuss this further, feel free to

call me.

>

> Jim <///><

> X 110

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> Medicare billing question

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>

> Group,

>

> I am getting some conflicting info regarding the frequency of billing

Medicare.

> I am an ORF, we do PT and speech therapy. Am I required to bill

Medicare at the

> end of the month or can I bill Medicare daily for PT services?

>

> Thanks in advance,

> Hankins, PT

> President

> Synergy Therapies, LLC

>

>

[Guest guest]

I believe the responses below indicate what has been stated before. Even though

the CMS Manual states one thing, your MAC has the ultimate say on the issue and

it will depend on what they allow. CMS regulations are set up for a reason.

While I cannot speak to the reasoning of why the manual was set up with these

guidelines, I can speculate fairly strongly. These guidelines were in place

back in the late 80's when I worked for a Medicare Intermediary. At that time

there was a huge concern about duplicate billing of services. The ability of

Medicare Intermediaries to track all of the transactions at that point in time

wasn't as far along as it is today. In Iowa, we used to have a client that

would bill for services twice a month. We were able to do this because at the

time we had an open dialogue going with the Medicare Intermediary. Although we

no longer bill for Rehab Agencies/Facilities in Iowa and Tennessee (which

allowed daily billing as well), we do bill for these services in New Jersey and

West Virginia. In New Jersey we can bill daily. In West Virginia, our client

elects to bill on a monthly basis..., but I believe we could probably bill more

frequently if the client wanted to.

Jim <///><

Medicare billing question

>

>

>

>

> Group,

>

> I am getting some conflicting info regarding the frequency of billing

Medicare.

> I am an ORF, we do PT and speech therapy. Am I required to bill

Medicare at the

> end of the month or can I bill Medicare daily for PT services?

>

> Thanks in advance,

> Hankins, PT

> President

> Synergy Therapies, LLC

>

>