RE: Med Pay Problem

[Guest guest]

Hopefully your financial policy indicates she is ultimately responsible.

When an attorney is involved it may also be helpful to get him and the

patient to sign a letter of protection so you will be guaranteed your

payment for services rendered despite the outcome of any settlement.

Sandy Schall, PT

President

Health-Pro Physical Therapy, Inc.

110 La Casa Via, Suite 100

Walnut Creek, CA 94598

Fax:

www.HealthProPT.com <http://www.healthpropt.com/>

HealthProPT@...

_____

From: Sandy@Pacer

Sent: Thursday, April 28, 2011 09:27 AM

To: mt_eden_pt@...; ptmanager ; Alternative Medical

Billing

Cc: Sims; Viel; Cali Phan; Candy Salinas; Donna Meyer; Jay

Mehta; Jill Watase; Weir; Lorelei Valencia; Rayndles; Robin

Casagranda; Sandy MacLean; Sandy Schall; Sherry ; Simon Gibson;

Watase; Vicki McDill

Subject: Re: Med Pay Problem

Hi guys we treated a gal on her auto med-pay. She signed paperwork etc.

Check from Farmers never came so we called and they said the attorney had

called them and told them they had to send all checks to the attorney. I

told the gal at Farmers that we don't take 3rd party patients and that when

we called to verify med-pay benefits we were told she had a certain amount.

This has never happened to us before where an attorney has swooped in and

taken our money. We have not had a call back from attorney yet. We called

Farmers a second time to complain but they said that was the law. Has

anyone heard of this??? Now I'm leary about taking med-pay patients. We

billed the patient immediately asking for payment in full. If she doesn't

pay within a reasonable amount of time she will go directly to collections.

Sandy @ pacer

Subject: Re: 95992 Denials Epley Maneuver Need help

To: mt_eden_pt@..., ptmanager

Cc: " Sims " , " Viel "

, " Candy

Salinas " , " Donna Meyer " , " Jay

Mehta " , "

Weir " , " Lorelei Valencia "

, " Rayndles " , " Robin

Casagranda " ,

" Sandy Schall " , " Sherry "

, " Simon Gibson " , "

Watase "

Date: Tuesday, April 26, 2011, 4:33 PM

Hi ,

I believe that it has a status B indicator code. As far as I know it does

not matter whether it is on a claim alone or in conjunction with another,

separate payment will not be made and the patient cannot be billed either.

From: Mt. Eden Physical

<http://us.mc817.mail.yahoo.com/mc/compose?to=mt_eden_ptsbcglobal (DOT) net>

Therapy

To: ptmanager

<http://us.mc817.mail.yahoo.com/mc/compose?to=ptmanager >

Cc: <http://us.mc817.mail.yahoo.com/mc/compose?to=acs44hotmail>

Sims ; Viel

<http://us.mc817.mail.yahoo.com/mc/compose?to=mt_eden_ptsbcglobal (DOT) net> ;

Cali <http://us.mc817.mail.yahoo.com/mc/compose?to=calimontclairpt>

Phan ; Candy

<http://us.mc817.mail.yahoo.com/mc/compose?to=csalinasnvptc> Salinas ;

Debbie Prusack

<http://us.mc817.mail.yahoo.com/mc/compose?to=alternativemedbillsbcglobal (DOT) n

et> ; Donna

<http://us.mc817.mail.yahoo.com/mc/compose?to=ddingdreamaol> Meyer ;

Jay <http://us.mc817.mail.yahoo.com/mc/compose?to=jaybayareapt> Mehta

; Jill <http://us.mc817.mail.yahoo.com/mc/compose?to=jwatasecomcast (DOT) net>

Watase ; Weir

<http://us.mc817.mail.yahoo.com/mc/compose?to=julielivermoreptgmail> ;

Lorelei Valencia

<http://us.mc817.mail.yahoo.com/mc/compose?to=berkeleyptgmail> ;

Rayndles

<http://us.mc817.mail.yahoo.com/mc/compose?to=billinglafayettept> ;

Robin <http://us.mc817.mail.yahoo.com/mc/compose?to=robinbayareapt>

Casagranda ; Sandy

<http://us.mc817.mail.yahoo.com/mc/compose?to=Pacersbcglobal (DOT) net> MacLean ;

Sandy Schall

<http://us.mc817.mail.yahoo.com/mc/compose?to=HealthProPTsbcglobal (DOT) net> ;

Sherry <http://us.mc817.mail.yahoo.com/mc/compose?to=aptsherry>

; Simon Gibson

<http://us.mc817.mail.yahoo.com/mc/compose?to=simonmontclairpt> ;

<http://us.mc817.mail.yahoo.com/mc/compose?to=vwataseaol>

Watase ; Vicki

<http://us.mc817.mail.yahoo.com/mc/compose?to=brklyvaol> McDill

Sent: Tuesday, April 26, 2011 12:25 PM

Subject: 95992 Denials Epley Maneuver Need help

Hi group:

I had read on the list serve that CMS had approved this therapy code for

payment. We do a lot of Epley Maneuver training, so I billed the code with

appropriate modifiers, only to get a denial. When I called Palmetto, our

intermediary, I was told " independent therapists " cannot charge this code.

The denial code is PR170. " Payment is denied when performed/billed by this

type of provider. "

I have been to the CMS website and have learned that the code is a

" sometimes " code with a detailed explanation of what a " sometimes " code

means. I've retyped the explanation below. I really can't figure out why

Palmetto won't pay the code. Does anyone have an explanation? Is someone

better at Medicare-Speak than I am?

And now that this code has been denied, what should I be billing for the

therapists' time?

" CMS:

These HCPCS?CPT codes (95992 is listed) sometimes represent therapy

services. However, these codes always represent therapy services and

require the use of a therapy modifier when performed by therapists.

There are some circumstances when these codes will not be considered

representative of therapy services and therapy limits (when they are in

effect) will not apply. Codes marked 7 are not therapy services when:

It is not appropriate to bill the service under a therapy plan of care, and

They are billed by practitioners/providers of services who are not

therapists, i.e., physicians, clinical nurse specialists, nurse

practitioners and psychologists; or they are billed to fiscal intermediaries

by hospitals for outpatient services which are performed by non-therapists

as noted in Note E above.

While the " 7 " designates that a particular HCPCSCPT code will not of itself

always indicate that a therapy service was rendered, these codes always

represent therapy services when rendered by therapists or by practitioners

who are not therapists in situations where the service provided is integral

to an outpatient rehabilitation therapy plan of care. For these situations,

these codes must always have a therapy modifier. For example, when the

service is rendered by either a doctor of medicine or a nurse practitioner

(acting within the scope of his or her license when performing such

service), with the goal of rehabilitation, a modifier is required. When

there is doubt about whether a service should be part of a therapy plan of

care, the contractor shall make that determination. "

Viel, Office Manager

Mt. Eden Physical Therapy Center

19845 Lake Chabot Road, Suite 205

Castro Valley, CA 94546

FAX

www.mtedenpt.com

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