Guest guest Posted December 29, 2011 Report Share Posted December 29, 2011 Hi , Can you be more specific about your denials? What is being denied and under what circumstance? That would help. Also you may look up the list of required Medicare documentation that is available if you search under Medicare compliance or Medicare audit. I don't have it with me but if no-one posts it here, I will send it to you this evening. This list has a checklist of what Medicare requires in documentation and is there specifically to help those that are audited or get denials to know what is required. One thing I also need to ask is that are you sending the H & P (do you mean the PT evaluation?) or are you sending in the Medicare Certification? Medicare requires the physician certification not the PT eval. Most clinics today have combined their evaluation form into a Medicare certification format so that the evaluation contains all the necessary information for Medicare Certification and that gets sent to the patient's physician for signature. The Certification,signed by the physician, daily notes (in proper Medicare format) and required Medicare Progress Notes (done every 10th visit or 30 days whichever comes first)>must also be included in most appeals of denials. If you give us more info about the denials, we can be a little more specific with the answer. Thanks. Tom Howell, PT, MPT IPTA Payment Specialist Meridian, ID thowell@... We are getting denials from Medicare requesting documentation and when > we send the H & P is not enought to determine medical necessity. Does > anyone have any suggestion on what else we need to provide or what needs > to be documented in the H & P for reimbursement? Thank you. > > L. Bash, CPC, CPC-H > Billing Director > HealthCare America Medical Group > HCA Physician Services > 3501 Cortez Road West > Bradenton, FL 34210 > Office: ext. 1019 > Cell: > Fax: Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 29, 2011 Report Share Posted December 29, 2011 Hi , Can you be more specific about your denials? What is being denied and under what circumstance? That would help. Also you may look up the list of required Medicare documentation that is available if you search under Medicare compliance or Medicare audit. I don't have it with me but if no-one posts it here, I will send it to you this evening. This list has a checklist of what Medicare requires in documentation and is there specifically to help those that are audited or get denials to know what is required. One thing I also need to ask is that are you sending the H & P (do you mean the PT evaluation?) or are you sending in the Medicare Certification? Medicare requires the physician certification not the PT eval. Most clinics today have combined their evaluation form into a Medicare certification format so that the evaluation contains all the necessary information for Medicare Certification and that gets sent to the patient's physician for signature. The Certification,signed by the physician, daily notes (in proper Medicare format) and required Medicare Progress Notes (done every 10th visit or 30 days whichever comes first)>must also be included in most appeals of denials. If you give us more info about the denials, we can be a little more specific with the answer. Thanks. Tom Howell, PT, MPT IPTA Payment Specialist Meridian, ID thowell@... We are getting denials from Medicare requesting documentation and when > we send the H & P is not enought to determine medical necessity. Does > anyone have any suggestion on what else we need to provide or what needs > to be documented in the H & P for reimbursement? Thank you. > > L. Bash, CPC, CPC-H > Billing Director > HealthCare America Medical Group > HCA Physician Services > 3501 Cortez Road West > Bradenton, FL 34210 > Office: ext. 1019 > Cell: > Fax: Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 29, 2011 Report Share Posted December 29, 2011 Hi , Can you be more specific about your denials? What is being denied and under what circumstance? That would help. Also you may look up the list of required Medicare documentation that is available if you search under Medicare compliance or Medicare audit. I don't have it with me but if no-one posts it here, I will send it to you this evening. This list has a checklist of what Medicare requires in documentation and is there specifically to help those that are audited or get denials to know what is required. One thing I also need to ask is that are you sending the H & P (do you mean the PT evaluation?) or are you sending in the Medicare Certification? Medicare requires the physician certification not the PT eval. Most clinics today have combined their evaluation form into a Medicare certification format so that the evaluation contains all the necessary information for Medicare Certification and that gets sent to the patient's physician for signature. The Certification,signed by the physician, daily notes (in proper Medicare format) and required Medicare Progress Notes (done every 10th visit or 30 days whichever comes first)>must also be included in most appeals of denials. If you give us more info about the denials, we can be a little more specific with the answer. Thanks. Tom Howell, PT, MPT IPTA Payment Specialist Meridian, ID thowell@... We are getting denials from Medicare requesting documentation and when > we send the H & P is not enought to determine medical necessity. Does > anyone have any suggestion on what else we need to provide or what needs > to be documented in the H & P for reimbursement? Thank you. > > L. Bash, CPC, CPC-H > Billing Director > HealthCare America Medical Group > HCA Physician Services > 3501 Cortez Road West > Bradenton, FL 34210 > Office: ext. 1019 > Cell: > Fax: Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 29, 2011 Report Share Posted December 29, 2011 You need to send in all documentation, including the certified plan of care, that would support the medical necessity of the dates of service being reviewed. This would include the initial evaluation, daily treatment notes, and applicable Progress Reports, re-evaluations, and DC Report. Rick Gawenda, PT President Gawenda Seminars & Consulting, Inc. www.gawendaseminars.com Follow Gawenda Seminars & Consulting, Inc on Facebook Register for January 24, 2012 audio conference " 2012 Medicare & Private Payor Updates " at https://www.showmyevent.com/events/viewEventDetails.aspx?EventID=1735 Subject: 97110 & 97032 To: PTManager Date: Thursday, December 29, 2011, 12:16 PM Â We are getting denials from Medicare requesting documentation and when we send the H & P is not enought to determine medical necessity. Does anyone have any suggestion on what else we need to provide or what needs to be documented in the H & P for reimbursement? Thank you. L. Bash, CPC, CPC-H Billing Director HealthCare America Medical Group HCA Physician Services 3501 Cortez Road West Bradenton, FL 34210 Office: ext. 1019 Cell: Fax: Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 29, 2011 Report Share Posted December 29, 2011 You need to send in all documentation, including the certified plan of care, that would support the medical necessity of the dates of service being reviewed. This would include the initial evaluation, daily treatment notes, and applicable Progress Reports, re-evaluations, and DC Report. Rick Gawenda, PT President Gawenda Seminars & Consulting, Inc. www.gawendaseminars.com Follow Gawenda Seminars & Consulting, Inc on Facebook Register for January 24, 2012 audio conference " 2012 Medicare & Private Payor Updates " at https://www.showmyevent.com/events/viewEventDetails.aspx?EventID=1735 Subject: 97110 & 97032 To: PTManager Date: Thursday, December 29, 2011, 12:16 PM Â We are getting denials from Medicare requesting documentation and when we send the H & P is not enought to determine medical necessity. Does anyone have any suggestion on what else we need to provide or what needs to be documented in the H & P for reimbursement? Thank you. L. Bash, CPC, CPC-H Billing Director HealthCare America Medical Group HCA Physician Services 3501 Cortez Road West Bradenton, FL 34210 Office: ext. 1019 Cell: Fax: Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 29, 2011 Report Share Posted December 29, 2011 You need to send in all documentation, including the certified plan of care, that would support the medical necessity of the dates of service being reviewed. This would include the initial evaluation, daily treatment notes, and applicable Progress Reports, re-evaluations, and DC Report. Rick Gawenda, PT President Gawenda Seminars & Consulting, Inc. www.gawendaseminars.com Follow Gawenda Seminars & Consulting, Inc on Facebook Register for January 24, 2012 audio conference " 2012 Medicare & Private Payor Updates " at https://www.showmyevent.com/events/viewEventDetails.aspx?EventID=1735 Subject: 97110 & 97032 To: PTManager Date: Thursday, December 29, 2011, 12:16 PM Â We are getting denials from Medicare requesting documentation and when we send the H & P is not enought to determine medical necessity. Does anyone have any suggestion on what else we need to provide or what needs to be documented in the H & P for reimbursement? Thank you. L. Bash, CPC, CPC-H Billing Director HealthCare America Medical Group HCA Physician Services 3501 Cortez Road West Bradenton, FL 34210 Office: ext. 1019 Cell: Fax: Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 29, 2011 Report Share Posted December 29, 2011 Do you have the modifers on it? Which are you using Re: 97110 & 97032 Hi , an you be more specific about your denials? What is being denied and nder what circumstance? That would help. Also you may look up the list f required Medicare documentation that is available if you search under edicare compliance or Medicare audit. I don't have it with me but if o-one posts it here, I will send it to you this evening. This list has a hecklist of what Medicare requires in documentation and is there pecifically to help those that are audited or get denials to know what is equired. One thing I also need to ask is that are you sending the H & P (do you ean the PT evaluation?) or are you sending in the Medicare Certification? Medicare requires the physician certification not the PT eval. Most linics today have combined their evaluation form into a Medicare ertification format so that the evaluation contains all the necessary nformation for Medicare Certification and that gets sent to the patient's hysician for signature. The Certification,signed by the physician, daily otes (in proper Medicare format) and required Medicare Progress Notes done every 10th visit or 30 days whichever comes first)>must also be ncluded in most appeals of denials. If you give us more info about the denials, we can be a little more pecific with the answer. hanks. om Howell, PT, MPT PTA Payment Specialist eridian, ID howell@... We are getting denials from Medicare requesting documentation and when we send the H & P is not enought to determine medical necessity. Does anyone have any suggestion on what else we need to provide or what needs to be documented in the H & P for reimbursement? Thank you. L. Bash, CPC, CPC-H Billing Director HealthCare America Medical Group HCA Physician Services 3501 Cortez Road West Bradenton, FL 34210 Office: ext. 1019 Cell: Fax: ------------------------------------ In ALL messages to PTManager you must identify yourself, your discipline and our location or else your message will not be approved to send to the full roup. Physician Self Referal/Referral for Profit {POPTS} is a serious threat to our rofessions. PTManager is not available to support POPTS-model practices. The escription of PTManager group includes the following: PTManager believes in and supports Therapist-owned Therapy Practices ONLY " essages relating to " how to set up a POPTS " will not be approved PTManager encourages participation in your professional association. Join APTA, OTA or ASHA and participate now! Follow Kovacek, PT on Facebook or Twitter. TManager blog: http://ptmanager.posterous.com/ ahoo! Groups Links Individual Email | Traditional http://docs.yahoo.com/info/terms/ Quote Link to comment Share on other sites More sharing options...
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