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 Hi, Merle - Thanks for raising a pertinent issue! One very important issue is that one must only bill for the precise CPT Code which they actually perform. If the therapist performs Range of Motion Measurements and records their findings, then they may bill for range of motion measurement. If they also perform manual muscle testing, then they may bill for manual muscle testing. If they did not perform Manual Therapy techniques, they may not bill for manual therapy. When performing manual therapy techniques, one is constantly re-assessing and proceding as indicated, but this does not add billable CPT Codes to the visit. CPT 97002, Re-Evaluation is a separate process -- and a separate document. It is generally used when there has been a significant change in a patient's condition, such as when a hip fracture patient who had become able to walk 400 ft on a two wheeled walker on the sidewalk subsequently experiences seizures, the force of which re-opens a former PEG tube site, and has been on bed rest for a week. (This happened last month!) Re-eval is not a billing code to use casually, or just to write up a progress note to the physician for the patient's follow-up visit. It's a real evaluation of an existing, rather than new, patient. Organizations should check their charts intermittently and re-train its staff to: 1) Do the indicated procedure, 2) Document what they have done, and 3) Bill for exactly what they have done that they have documented. I once knew a DPM inTexas who combined the billing for two procedures which he *did* perform into a charge for one " sort of close " procedure which he *did not* actually perform. The insurance company took action against his license for fraud, and he was banned from Medicare program for five years. It's better to coach your staff (and owners, if necessary) to just do the right thing. Lawyers are far too costly! Hope that's useful! Dr. Dick Hillyer, PT Dr. Hillyer, PT,DPT,MBA,MSM Hillyer Consulting 700 El Dorado Pkwy W. Cape Coral, FL 33914 Mobile _____ From: PTManager [mailto:PTManager ] On Behalf Of Freeman, Meryl Sent: Thursday, June 02, 2011 3:45 PM To: PTManager Subject: Billing question 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 2, 2011 Report Share Posted June 2, 2011 Hi, Merle - Thanks for raising a pertinent issue! One very important issue is that one must only bill for the precise CPT Code which they actually perform. If the therapist performs Range of Motion Measurements and records their findings, then they may bill for range of motion measurement. If they also perform manual muscle testing, then they may bill for manual muscle testing. If they did not perform Manual Therapy techniques, they may not bill for manual therapy. When performing manual therapy techniques, one is constantly re-assessing and proceding as indicated, but this does not add billable CPT Codes to the visit. CPT 97002, Re-Evaluation is a separate process -- and a separate document. It is generally used when there has been a significant change in a patient's condition, such as when a hip fracture patient who had become able to walk 400 ft on a two wheeled walker on the sidewalk subsequently experiences seizures, the force of which re-opens a former PEG tube site, and has been on bed rest for a week. (This happened last month!) Re-eval is not a billing code to use casually, or just to write up a progress note to the physician for the patient's follow-up visit. It's a real evaluation of an existing, rather than new, patient. Organizations should check their charts intermittently and re-train its staff to: 1) Do the indicated procedure, 2) Document what they have done, and 3) Bill for exactly what they have done that they have documented. I once knew a DPM inTexas who combined the billing for two procedures which he *did* perform into a charge for one " sort of close " procedure which he *did not* actually perform. The insurance company took action against his license for fraud, and he was banned from Medicare program for five years. It's better to coach your staff (and owners, if necessary) to just do the right thing. Lawyers are far too costly! Hope that's useful! Dr. Dick Hillyer, PT Dr. Hillyer, PT,DPT,MBA,MSM Hillyer Consulting 700 El Dorado Pkwy W. Cape Coral, FL 33914 Mobile _____ From: PTManager [mailto:PTManager ] On Behalf Of Freeman, Meryl Sent: Thursday, June 02, 2011 3:45 PM To: PTManager Subject: Billing question 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 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@...>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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