Direction and clarity

[Guest guest]

I am struggling to find some answers and direction and am hoping you can help.

We seem to have some debate in using group codes, use of ATCs and " best " billing

practices in a 3 clinic outpatient setting. I have looked through contracts,

asked other therapists and individuals at our state level (Michigan). All of

whom state there are grey areas and cannot point to any black and white concrete

info on some issues we have. I will present a few scenarios and see where that

leads me (us).

     1.Do you use the group charge for other patients than MC (one MC pt and one

BC pt at the same time seen from 8:00 till 9:00?) or can you bill individually

for the BC pt and MC pt if you are using an aide to perform those designated

acts tasks and functions that are still kinda blurry to me with the BC pt?

     2.Since there is some ambiguity on the use of ATCs in the clinic (in

Michigan), is there any scenario, or payer mix, that would allow me to bill PT

services provided by an ATC in the clinic? I have seen in black and white where

MC states they will not reimburse for services if provided by anyone other than

a PT or PTA. I looked at the BC contract and the WC MVA info we have and could

not find anything one way or the other for them. Can I utilize an ATC to see

those pts and bill for it?

     3. How about a licensed Massage therapist doing massage on a WC or MVA pt?

Anything there?

Any help I can get would be greatly appreciated. There seems to be a vast array

of " interpretation " of these things and no one can show it to me in writing. I

would be happy to look into hiring a consultant to get us all on the same page

to keep us on track so as to not fall victim to the " ..oh I did not know that "

defense to an auditor if anyone has suggestions

Thanks,

Damon PT