RE: Medicare outpatient: care overlap at 2 clinics

[Guest guest]

Would make more sense to have therapy at the same clinic for both problems.

Have you asked him that? My clinic or the other, it would be in his best

interest.

Matt Dvorak, PT

Yankton, SD

________________________________

From: PTManager on behalf of Clay Jowers

Sent: Mon 11/7/2011 3:44 PM

To: PTManager

Subject: Medicare outpatient: care overlap at 2 clinics

OK group,

Have had a pt for a LE issue for the last 2-4wks. He just informed me today

that another MD referred him 2 wks ago to begin PT for his shoulder at a

different clinic, which the pt did begin. So my care has overlapped with the

other clinic.

Question:

1.Anyone know the procedure to go through for this, as I am unsure if this will

be an issue (I would think it is) with medicare billing simultaneously from 2

different clinics, though they are 2 seperate conditions/diagnoses.

2. What would I need to address as far as billing, and what if the other clinic

is not cooperative?

Thanks a bunch.

Clay Jowers, PT

[Guest guest]

Hi Clay,

My understanding of this is Medicare will allow this only if your clinic

could not provide the shoulder service at your clinic. For instance, if the

second case involved a referral for lymphedema management and no one at your

clinic was trained in that. If you do not have that situation, then both

sets of treatments could be denied. Do you meet the first criteria? If not

then, what I have seen recommended is that the patient will be informed of

their right to choose one clinic or the other and that they must choose or

else the treatment at both clinics will be denied. So if you do not meet

the first criteria then inform the patient and let them decide.

If you meet the criteria of not being able to provide the shoulder service

at your clinic, then I would have to defer to someone else on how that would

be billed. My understanding is that it would probably have to go through

the appeal process before you would have a chance to explain why the two

clinics were involved - I will need help on this part.

Once both areas are treated at one clinic, proper billing can be done with a

modifier appended to the billing to denote a separate and distinct area of

service. Your documentation then must match and have clear reasoning as to

why both areas must be treated. Some clinics will have patients come in on

separate days for separate cases to avoid having to append the modifier.

Either way if the services can be done at one clinic, they should be done at

one clinic. - That is my understanding and I hope others will respond as

well if this is not correct.

M.Howell, P.T., M.P.T.

IPTA Payment Specialist

Meridian, Idaho

thowell@...

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From: PTManager [mailto:PTManager ] On Behalf

Of Clay Jowers

Sent: Monday, November 07, 2011 2:44 PM

To: PTManager

Subject: Medicare outpatient: care overlap at 2 clinics

OK group,

Have had a pt for a LE issue for the last 2-4wks. He just informed me today

that another MD referred him 2 wks ago to begin PT for his shoulder at a

different clinic, which the pt did begin. So my care has overlapped with

the other clinic.

Question:

1.Anyone know the procedure to go through for this, as I am unsure if this

will be an issue (I would think it is) with medicare billing simultaneously

from 2 different clinics, though they are 2 seperate conditions/diagnoses.

2. What would I need to address as far as billing, and what if the other

clinic is not cooperative?

Thanks a bunch.

Clay Jowers, PT