Guest guest Posted June 2, 2011 Report Share Posted June 2, 2011 Hello group, We had a patient call in to complain about her bill today. She stated that on two visits, she was billed manual therapy, 1 unit and never had any manual therapy during those visits. I checked back in the documentation (this is a non-Medicare patient, but our hospital requires us to bill all payers the same). On the first visit, the only thing documented in the chart were measurements of range of motion and manual muscle testing. Under subjective, the patient reported 95% pain relief and the therapist wrote in the assessment/plan " patient doing well, hold chart for 2 weeks- if no further complaints, d/c " ). The next and last visit was 2 weeks later. The patient had an exacerbation. There was more objective testing documented and some ther ex reviewed and modified. Here is what the therapist documented as far as billing: for Visit 1, she billed Manual Therapy, 15 minutes. For visit two, she billed Manual Therapy 20 minutes. My take is that since she can't bill re-eval for Visit 1, she was correct in her billing for that visit. However, she didn't bill for what she documented on Visit 2- her total time was 20 minutes (1 unit), but she didn't break it down by each procedure- it is unclear from her documentation as to which unit she spent more time. So question to the group- do you agree with how she billed? Any suggestions on a simple way to explain our very complicated billing system to a patient who has no clue? Thanks Meryl W. Freeman, MS PT Manager, Rex Hospital Outpatient Rehab (office) ----- Confidentiality Notice ----- This e-mail and any attached documents contain confidential information belonging to the sending entity, Rex Healthcare, and is intended only for the use of the individual(s) or entity(s) associated with the recipient addresses listed in the message header. The authorized recipient of this information is prohibited from disclosing this information to any other party. If you are not the intended recipient, you are hereby notified that any disclosure, copying, distribution or action taken in reliance on the contents of the email and/or attachments is strictly prohibited. If you received this e-mail transmission in error, please notify the sender immediately to arrange for return or destruction of this information. To report abuse or inappropriate use, please email abuse@....( Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 2, 2011 Report Share Posted June 2, 2011 Meryl, I don't see how manual therapy was charged for either visit. ???? Documentation should clearly support all CPT charges. The scenario you mention does not do this. Chart Audit Rule: If it wasn't clearly documented, it wasn't done. Jon Mark Pleasant, PT Methodist Medical Center > > Hello group, > > We had a patient call in to complain about her bill today. She stated > that on two visits, she was billed manual therapy, 1 unit and never had > any manual therapy during those visits. I checked back in the > documentation (this is a non-Medicare patient, but our hospital requires > us to bill all payers the same). On the first visit, the only thing > documented in the chart were measurements of range of motion and manual > muscle testing. Under subjective, the patient reported 95% pain relief > and the therapist wrote in the assessment/plan " patient doing well, hold > chart for 2 weeks- if no further complaints, d/c " ). The next and last > visit was 2 weeks later. The patient had an exacerbation. There was > more objective testing documented and some ther ex reviewed and > modified. > > Here is what the therapist documented as far as billing: for Visit 1, > she billed Manual Therapy, 15 minutes. For visit two, she billed Manual > Therapy 20 minutes. My take is that since she can't bill re-eval for > Visit 1, she was correct in her billing for that visit. However, she > didn't bill for what she documented on Visit 2- her total time was 20 > minutes (1 unit), but she didn't break it down by each procedure- it is > unclear from her documentation as to which unit she spent more time. > > So question to the group- do you agree with how she billed? Any > suggestions on a simple way to explain our very complicated billing > system to a patient who has no clue? > > Thanks > > Meryl W. Freeman, MS PT > Manager, Rex Hospital Outpatient Rehab > (office) > > > > ----- Confidentiality Notice ----- > This e-mail and any attached documents contain confidential information > belonging to the sending entity, Rex Healthcare, and is intended only for the > use of the individual(s) or entity(s) associated with the recipient addresses > listed in the message header. The authorized recipient of this information is > prohibited from disclosing this information to any other party. If you are not > the intended recipient, you are hereby notified that any disclosure, copying, > distribution or action taken in reliance on the contents of the email and/or > attachments is strictly prohibited. If you received this e-mail transmission in > error, please notify the sender immediately to arrange for return or > destruction of this information. > > To report abuse or inappropriate use, please email abuse@...( > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 2, 2011 Report Share Posted June 2, 2011 Meryl, I don't see how manual therapy was charged for either visit. ???? Documentation should clearly support all CPT charges. The scenario you mention does not do this. Chart Audit Rule: If it wasn't clearly documented, it wasn't done. Jon Mark Pleasant, PT Methodist Medical Center > > Hello group, > > We had a patient call in to complain about her bill today. She stated > that on two visits, she was billed manual therapy, 1 unit and never had > any manual therapy during those visits. I checked back in the > documentation (this is a non-Medicare patient, but our hospital requires > us to bill all payers the same). On the first visit, the only thing > documented in the chart were measurements of range of motion and manual > muscle testing. Under subjective, the patient reported 95% pain relief > and the therapist wrote in the assessment/plan " patient doing well, hold > chart for 2 weeks- if no further complaints, d/c " ). The next and last > visit was 2 weeks later. The patient had an exacerbation. There was > more objective testing documented and some ther ex reviewed and > modified. > > Here is what the therapist documented as far as billing: for Visit 1, > she billed Manual Therapy, 15 minutes. For visit two, she billed Manual > Therapy 20 minutes. My take is that since she can't bill re-eval for > Visit 1, she was correct in her billing for that visit. However, she > didn't bill for what she documented on Visit 2- her total time was 20 > minutes (1 unit), but she didn't break it down by each procedure- it is > unclear from her documentation as to which unit she spent more time. > > So question to the group- do you agree with how she billed? Any > suggestions on a simple way to explain our very complicated billing > system to a patient who has no clue? > > Thanks > > Meryl W. Freeman, MS PT > Manager, Rex Hospital Outpatient Rehab > (office) > > > > ----- Confidentiality Notice ----- > This e-mail and any attached documents contain confidential information > belonging to the sending entity, Rex Healthcare, and is intended only for the > use of the individual(s) or entity(s) associated with the recipient addresses > listed in the message header. The authorized recipient of this information is > prohibited from disclosing this information to any other party. If you are not > the intended recipient, you are hereby notified that any disclosure, copying, > distribution or action taken in reliance on the contents of the email and/or > attachments is strictly prohibited. If you received this e-mail transmission in > error, please notify the sender immediately to arrange for return or > destruction of this information. > > To report abuse or inappropriate use, please email abuse@...( > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 2, 2011 Report Share Posted June 2, 2011 Hi, Meryl, Sounds like this patient has more than a clue. The documentation as you presented it does not support the charges for manual therapy. Better that she told you instead of filing a complaint with her insurance company! Visit 1: MMT is not a manual therapy procedure. It is more closely aligned with 97110-Therapeutic Exercise, which is also concerned with strength and ROM. Alternatively, MMT and ROM assessment could be charged with 97750-Physical Performance Test w/ Report *if* the therapist followed standardized test protocols and documented the results. There are also specific codes for these measurements, if standard protocols are followed (e.g. 95831-MMT extremity excluding hand) Visit 2: The documentation does not support the manual therapy charge, unless part of the " more objective testing " she performed was joint mobility testing, palpation of soft tissue, etc. She isn't required to break down the 20 minutes by procedure, just bill one unit for the timed procedure she spent the most time on and make sure her documentation supports it. Explaining our complicated billing system to *staff *is often a challenge, but it is critical that managers are proficient with this. We should document staff training in both correct use of the billing code *and*documentation to support that medically-necessary and skilled care was provided to support that code. Every therapist in another therapist's chain of command may be held legally responsible for her practice of inaccurate billing. Part of the APTA Code of Ethics is that we bill accurately for services that we provide. I highly recommend the APTA billing and coding course, and Rick Gawenda's audio conferences (much more engaging than reading the CPT coding book!) Diane , PT Augusta, GA On Thu, Jun 2, 2011 at 3:45 PM, Freeman, Meryl wrote: > > > Hello group, > > We had a patient call in to complain about her bill today. She stated > that on two visits, she was billed manual therapy, 1 unit and never had > any manual therapy during those visits. I checked back in the > documentation (this is a non-Medicare patient, but our hospital requires > us to bill all payers the same). On the first visit, the only thing > documented in the chart were measurements of range of motion and manual > muscle testing. Under subjective, the patient reported 95% pain relief > and the therapist wrote in the assessment/plan " patient doing well, hold > chart for 2 weeks- if no further complaints, d/c " ). The next and last > visit was 2 weeks later. The patient had an exacerbation. There was > more objective testing documented and some ther ex reviewed and > modified. > > Here is what the therapist documented as far as billing: for Visit 1, > she billed Manual Therapy, 15 minutes. For visit two, she billed Manual > Therapy 20 minutes. My take is that since she can't bill re-eval for > Visit 1, she was correct in her billing for that visit. However, she > didn't bill for what she documented on Visit 2- her total time was 20 > minutes (1 unit), but she didn't break it down by each procedure- it is > unclear from her documentation as to which unit she spent more time. > > So question to the group- do you agree with how she billed? Any > suggestions on a simple way to explain our very complicated billing > system to a patient who has no clue? > > Thanks > > Meryl W. Freeman, MS PT > Manager, Rex Hospital Outpatient Rehab > (office) > > ----- Confidentiality Notice ----- > This e-mail and any attached documents contain confidential information > belonging to the sending entity, Rex Healthcare, and is intended only for > the > use of the individual(s) or entity(s) associated with the recipient > addresses > listed in the message header. The authorized recipient of this information > is > prohibited from disclosing this information to any other party. If you are > not > the intended recipient, you are hereby notified that any disclosure, > copying, > distribution or action taken in reliance on the contents of the email > and/or > attachments is strictly prohibited. If you received this e-mail > transmission in > error, please notify the sender immediately to arrange for return or > destruction of this information. > > To report abuse or inappropriate use, please email abuse@....( > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 2, 2011 Report Share Posted June 2, 2011 Hi, Meryl, Sounds like this patient has more than a clue. The documentation as you presented it does not support the charges for manual therapy. Better that she told you instead of filing a complaint with her insurance company! Visit 1: MMT is not a manual therapy procedure. It is more closely aligned with 97110-Therapeutic Exercise, which is also concerned with strength and ROM. Alternatively, MMT and ROM assessment could be charged with 97750-Physical Performance Test w/ Report *if* the therapist followed standardized test protocols and documented the results. There are also specific codes for these measurements, if standard protocols are followed (e.g. 95831-MMT extremity excluding hand) Visit 2: The documentation does not support the manual therapy charge, unless part of the " more objective testing " she performed was joint mobility testing, palpation of soft tissue, etc. She isn't required to break down the 20 minutes by procedure, just bill one unit for the timed procedure she spent the most time on and make sure her documentation supports it. Explaining our complicated billing system to *staff *is often a challenge, but it is critical that managers are proficient with this. We should document staff training in both correct use of the billing code *and*documentation to support that medically-necessary and skilled care was provided to support that code. Every therapist in another therapist's chain of command may be held legally responsible for her practice of inaccurate billing. Part of the APTA Code of Ethics is that we bill accurately for services that we provide. I highly recommend the APTA billing and coding course, and Rick Gawenda's audio conferences (much more engaging than reading the CPT coding book!) Diane , PT Augusta, GA On Thu, Jun 2, 2011 at 3:45 PM, Freeman, Meryl wrote: > > > Hello group, > > We had a patient call in to complain about her bill today. She stated > that on two visits, she was billed manual therapy, 1 unit and never had > any manual therapy during those visits. I checked back in the > documentation (this is a non-Medicare patient, but our hospital requires > us to bill all payers the same). On the first visit, the only thing > documented in the chart were measurements of range of motion and manual > muscle testing. Under subjective, the patient reported 95% pain relief > and the therapist wrote in the assessment/plan " patient doing well, hold > chart for 2 weeks- if no further complaints, d/c " ). The next and last > visit was 2 weeks later. The patient had an exacerbation. There was > more objective testing documented and some ther ex reviewed and > modified. > > Here is what the therapist documented as far as billing: for Visit 1, > she billed Manual Therapy, 15 minutes. For visit two, she billed Manual > Therapy 20 minutes. My take is that since she can't bill re-eval for > Visit 1, she was correct in her billing for that visit. However, she > didn't bill for what she documented on Visit 2- her total time was 20 > minutes (1 unit), but she didn't break it down by each procedure- it is > unclear from her documentation as to which unit she spent more time. > > So question to the group- do you agree with how she billed? Any > suggestions on a simple way to explain our very complicated billing > system to a patient who has no clue? > > Thanks > > Meryl W. Freeman, MS PT > Manager, Rex Hospital Outpatient Rehab > (office) > > ----- Confidentiality Notice ----- > This e-mail and any attached documents contain confidential information > belonging to the sending entity, Rex Healthcare, and is intended only for > the > use of the individual(s) or entity(s) associated with the recipient > addresses > listed in the message header. The authorized recipient of this information > is > prohibited from disclosing this information to any other party. If you are > not > the intended recipient, you are hereby notified that any disclosure, > copying, > distribution or action taken in reliance on the contents of the email > and/or > attachments is strictly prohibited. If you received this e-mail > transmission in > error, please notify the sender immediately to arrange for return or > destruction of this information. > > To report abuse or inappropriate use, please email abuse@....( > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 3, 2011 Report Share Posted June 3, 2011 I don't think that all of this is gray. The patient is right- she didn't have manual therapy (because if it is not in the note so therefore it didn't happen) and she doesn't deserve to be billed for it. I think the more important action that needs to take place is to explain to the patient the billing error and correct the service or write it off. What an opportunity to reiterate to your staff how important it is that your daily note matches what is billed! Hodges, MPT Clinic Manager Sacred Heart Rehabilitation Center at Panama City Beach fax ________________________________ From: PTManager [mailto:PTManager ] On Behalf Of Freeman, Meryl Sent: Friday, June 03, 2011 5:48 AM To: PTManager Subject: RE: Billing question Thanks Diane, Dick, and Jon for your responses. My staff had a lively discussion about this and wanted a black and white answer. Your varying responses prove that this may not be black and white! :-) For the record, I've taken Rick Gawenda's course twice, and I'm going to a refresher next month. When making my determination for the billing of manual therapy, I referred to Slide 213 in his presentation, page 71 in his manual (Rick, chime in any time now!). Disclaimer- this manual is from a few years ago. Here is what the slide said: CMS Definitions- Assessment: * Minutes spent assessing the patient are billed under the appropriate CPT code * For example, patient comes in for follow-up treatment complaining of neck pain and stiffness. The PT assesses cervical ROM, palpates the cervical region, and determines the patient requires manual therapy. Those minutes assessing the patient would be counted under the manual therapy when determining the billing. So I guess the question is, in both of the visits, actual manual therapy treatment was *not* performed. In visit 2, therapeutic exercise was. So in that respect, I would agree with Diane in billing ther ex in visit 2. From reading the definition of the ROM/MMT and 97750 codes, the report requirement is what throws us. We use 97750 for Berg Balance and our " report " consists of a separate page of documentation with a short interpretation section. According to the definition, the " report " has to be a separate and distinctly identifiable signed written report that includes the provider's interpretation of the results. Is anyone doing that for the MMT and ROM codes? Could you possibly send me an example of a report? Diane, I do agree, explaining all of this to the staff is a *nightmare*, let alone explaining it to a patient! Thanks all. Meryl Re: Billing question Hi, Meryl, Sounds like this patient has more than a clue. The documentation as you presented it does not support the charges for manual therapy. Better that she told you instead of filing a complaint with her insurance company! Visit 1: MMT is not a manual therapy procedure. It is more closely aligned with 97110-Therapeutic Exercise, which is also concerned with strength and ROM. Alternatively, MMT and ROM assessment could be charged with 97750-Physical Performance Test w/ Report *if* the therapist followed standardized test protocols and documented the results. There are also specific codes for these measurements, if standard protocols are followed (e.g. 95831-MMT extremity excluding hand) Visit 2: The documentation does not support the manual therapy charge, unless part of the " more objective testing " she performed was joint mobility testing, palpation of soft tissue, etc. She isn't required to break down the 20 minutes by procedure, just bill one unit for the timed procedure she spent the most time on and make sure her documentation supports it. Explaining our complicated billing system to *staff *is often a challenge, but it is critical that managers are proficient with this. We should document staff training in both correct use of the billing code *and*documentation to support that medically-necessary and skilled care was provided to support that code. Every therapist in another therapist's chain of command may be held legally responsible for her practice of inaccurate billing. Part of the APTA Code of Ethics is that we bill accurately for services that we provide. I highly recommend the APTA billing and coding course, and Rick Gawenda's audio conferences (much more engaging than reading the CPT coding book!) Diane , PT Augusta, GA On Thu, Jun 2, 2011 at 3:45 PM, Freeman, Meryl <Meryl.Freeman@...<mailto:Meryl.Freeman%40rexhealth.com> <mailto:Meryl.Freeman%40rexhealth.com> >wrote: > > > Hello group, > > We had a patient call in to complain about her bill today. She stated > that on two visits, she was billed manual therapy, 1 unit and never had > any manual therapy during those visits. I checked back in the > documentation (this is a non-Medicare patient, but our hospital requires > us to bill all payers the same). On the first visit, the only thing > documented in the chart were measurements of range of motion and manual > muscle testing. Under subjective, the patient reported 95% pain relief > and the therapist wrote in the assessment/plan " patient doing well, hold > chart for 2 weeks- if no further complaints, d/c " ). The next and last > visit was 2 weeks later. The patient had an exacerbation. There was > more objective testing documented and some ther ex reviewed and > modified. > > Here is what the therapist documented as far as billing: for Visit 1, > she billed Manual Therapy, 15 minutes. For visit two, she billed Manual > Therapy 20 minutes. My take is that since she can't bill re-eval for > Visit 1, she was correct in her billing for that visit. However, she > didn't bill for what she documented on Visit 2- her total time was 20 > minutes (1 unit), but she didn't break it down by each procedure- it is > unclear from her documentation as to which unit she spent more time. > > So question to the group- do you agree with how she billed? Any > suggestions on a simple way to explain our very complicated billing > system to a patient who has no clue? > > Thanks > > Meryl W. Freeman, MS PT > Manager, Rex Hospital Outpatient Rehab > (office) > > ----- Confidentiality Notice ----- > This e-mail and any attached documents contain confidential information > belonging to the sending entity, Rex Healthcare, and is intended only for > the > use of the individual(s) or entity(s) associated with the recipient > addresses > listed in the message header. The authorized recipient of this information > is > prohibited from disclosing this information to any other party. If you are > not > the intended recipient, you are hereby notified that any disclosure, > copying, > distribution or action taken in reliance on the contents of the email > and/or > attachments is strictly prohibited. If you received this e-mail > transmission in > error, please notify the sender immediately to arrange for return or > destruction of this information. > > To report abuse or inappropriate use, please email abuse@...<mailto:abuse%40rexhealth.com> <mailto:abuse%40rexhealth.com> ..( > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 3, 2011 Report Share Posted June 3, 2011 I hear you, Heidi. The good news- this particular insurance was negotiated at a per-visit rate. So no matter what we bill, our reimbursement and the patient co-pay is identical. We have corrected the coding, though. Thanks. From: PTManager [mailto:PTManager ] On Behalf Of Heidi Harmon Sent: Friday, June 03, 2011 10:09 AM To: PTManager Subject: Re: Billing question So why not correct the CPT codes and send in a corrected claim to ins co? Usually manal therapy is reimbursed lower than most other CPT so the patient will end up owing more and prob be sorry he/she complained. I do strictly billing not therapy so I am speaking from a billing perspective, not how you should and shouldn't code. But as the billing manager, I would talk to the therapist, ask for corrected codes and submit a corrected claim. Sounds like if the patient knows that much about CPT's something is fishy with complaining so I would be gentle but still get the money the clinic deserves for the treatment. Heidi Harmon\ Billing Manager Re: Billing question Hi, Meryl, Sounds like this patient has more than a clue. The documentation as you resented it does not support the charges for manual therapy. Better that he told you instead of filing a complaint with her insurance company! Visit 1: MMT is not a manual therapy procedure. It is more closely aligned ith 97110-Therapeutic Exercise, which is also concerned with strength and OM. Alternatively, MMT and ROM assessment could be charged with 7750-Physical Performance Test w/ Report *if* the therapist followed tandardized test protocols and documented the results. There are also pecific codes for these measurements, if standard protocols are followed e.g. 95831-MMT extremity excluding hand) isit 2: The documentation does not support the manual therapy charge, nless part of the " more objective testing " she performed was joint mobility esting, palpation of soft tissue, etc. She isn't required to break down he 20 minutes by procedure, just bill one unit for the timed procedure she pent the most time on and make sure her documentation supports it. Explaining our complicated billing system to *staff *is often a challenge, ut it is critical that managers are proficient with this. We should ocument staff training in both correct use of the billing code and*documentation to support that medically-necessary and skilled are was rovided to support that code. Every therapist in another therapist's chain f command may be held legally responsible for her practice of inaccurate illing. Part of the APTA Code of Ethics is that we bill accurately for ervices that we provide. I highly recommend the APTA billing and coding course, and Rick Gawenda's udio conferences (much more engaging than reading the CPT coding book!) Diane , PT ugusta, GA On Thu, Jun 2, 2011 at 3:45 PM, Freeman, Meryl Meryl.Freeman@... <mailto:Meryl.Freeman%40rexhealth.com> >wrote: > Hello group, We had a patient call in to complain about her bill today. She stated that on two visits, she was billed manual therapy, 1 unit and never had any manual therapy during those visits. I checked back in the documentation (this is a non-Medicare patient, but our hospital requires us to bill all payers the same). On the first visit, the only thing documented in the chart were measurements of range of motion and manual muscle testing. Under subjective, the patient reported 95% pain relief and the therapist wrote in the assessment/plan " patient doing well, hold chart for 2 weeks- if no further complaints, d/c " ). The next and last visit was 2 weeks later. The patient had an exacerbation. There was more objective testing documented and some ther ex reviewed and modified. Here is what the therapist documented as far as billing: for Visit 1, she billed Manual Therapy, 15 minutes. For visit two, she billed Manual Therapy 20 minutes. My take is that since she can't bill re-eval for Visit 1, she was correct in her billing for that visit. However, she didn't bill for what she documented on Visit 2- her total time was 20 minutes (1 unit), but she didn't break it down by each procedure- it is unclear from her documentation as to which unit she spent more time. So question to the group- do you agree with how she billed? Any suggestions on a simple way to explain our very complicated billing system to a patient who has no clue? Thanks Meryl W. Freeman, MS PT Manager, Rex Hospital Outpatient Rehab (office) ----- Confidentiality Notice ----- This e-mail and any attached documents contain confidential information belonging to the sending entity, Rex Healthcare, and is intended only for the use of the individual(s) or entity(s) associated with the recipient addresses listed in the message header. The authorized recipient of this information is prohibited from disclosing this information to any other party. If you are not the intended recipient, you are hereby notified that any disclosure, copying, distribution or action taken in reliance on the contents of the email and/or attachments is strictly prohibited. If you received this e-mail transmission in error, please notify the sender immediately to arrange for return or destruction of this information. To report abuse or inappropriate use, please email abuse@... <mailto:abuse%40rexhealth.com> .( Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 3, 2011 Report Share Posted June 3, 2011 Heidi Great point on the reimbursement side of the equation. All things being equal, it seems like a " no blood, no foul " type of issue. HOWEVER, depending on the circumstances, I have seen insurance companys come back and demand payment for a service that was not done. At that point you can make your case that it was at less expense to the insurance company and point out the time an appeal would have taken for the insurance carrier AND clinic personnel. In some instances you will find a " Reasonable " person that will understand and agree with your assessment. Unfortunately, in too many instances they will demand the claim be repaid and tell you to resubmit a corrected claim..., at which point they will deny for timely filing (or something else). And that is unfortunate, Jim <///>< Re: Billing question Hi, Meryl, Sounds like this patient has more than a clue. The documentation as you resented it does not support the charges for manual therapy. Better that he told you instead of filing a complaint with her insurance company! Visit 1: MMT is not a manual therapy procedure. It is more closely aligned ith 97110-Therapeutic Exercise, which is also concerned with strength and OM. Alternatively, MMT and ROM assessment could be charged with 7750-Physical Performance Test w/ Report *if* the therapist followed tandardized test protocols and documented the results. There are also pecific codes for these measurements, if standard protocols are followed e.g. 95831-MMT extremity excluding hand) isit 2: The documentation does not support the manual therapy charge, nless part of the " more objective testing " she performed was joint mobility esting, palpation of soft tissue, etc. She isn't required to break down he 20 minutes by procedure, just bill one unit for the timed procedure she pent the most time on and make sure her documentation supports it. Explaining our complicated billing system to *staff *is often a challenge, ut it is critical that managers are proficient with this. We should ocument staff training in both correct use of the billing code and*documentation to support that medically-necessary and skilled are was rovided to support that code. Every therapist in another therapist's chain f command may be held legally responsible for her practice of inaccurate illing. Part of the APTA Code of Ethics is that we bill accurately for ervices that we provide. I highly recommend the APTA billing and coding course, and Rick Gawenda's udio conferences (much more engaging than reading the CPT coding book!) Diane , PT ugusta, GA On Thu, Jun 2, 2011 at 3:45 PM, Freeman, Meryl Meryl.Freeman@...>wrote: > Hello group, We had a patient call in to complain about her bill today. She stated that on two visits, she was billed manual therapy, 1 unit and never had any manual therapy during those visits. I checked back in the documentation (this is a non-Medicare patient, but our hospital requires us to bill all payers the same). On the first visit, the only thing documented in the chart were measurements of range of motion and manual muscle testing. Under subjective, the patient reported 95% pain relief and the therapist wrote in the assessment/plan " patient doing well, hold chart for 2 weeks- if no further complaints, d/c " ). The next and last visit was 2 weeks later. The patient had an exacerbation. There was more objective testing documented and some ther ex reviewed and modified. Here is what the therapist documented as far as billing: for Visit 1, she billed Manual Therapy, 15 minutes. For visit two, she billed Manual Therapy 20 minutes. My take is that since she can't bill re-eval for Visit 1, she was correct in her billing for that visit. However, she didn't bill for what she documented on Visit 2- her total time was 20 minutes (1 unit), but she didn't break it down by each procedure- it is unclear from her documentation as to which unit she spent more time. So question to the group- do you agree with how she billed? Any suggestions on a simple way to explain our very complicated billing system to a patient who has no clue? Thanks Meryl W. Freeman, MS PT Manager, Rex Hospital Outpatient Rehab (office) ----- Confidentiality Notice ----- This e-mail and any attached documents contain confidential information belonging to the sending entity, Rex Healthcare, and is intended only for the use of the individual(s) or entity(s) associated with the recipient addresses listed in the message header. The authorized recipient of this information is prohibited from disclosing this information to any other party. If you are not the intended recipient, you are hereby notified that any disclosure, copying, distribution or action taken in reliance on the contents of the email and/or attachments is strictly prohibited. If you received this e-mail transmission in error, please notify the sender immediately to arrange for return or destruction of this information. To report abuse or inappropriate use, please email abuse@....( Quote Link to comment Share on other sites More sharing options...
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