Guest guest Posted August 15, 2012 Report Share Posted August 15, 2012 I appreciate your response and would never tell a skilled PT what to code....just provide the education to them regarding the reimbursement of the codes....This is something they are requesting..not me. But thank you. RE: CPT Codes/Audits With all due respect, rovision of skilled care is dictated by what the patient needs, not by he code that brings a higher reimbursement. E is TE , TA is TA, and so on. he therapist is the one to determine and be responsible for the ustification behind the use of the code/charge he CPT code book provides the definition, and the skilled therapy rovided must support its use, there is no wiggle room Ron Barbato PT dministrative Director, Rehabilitation Services rogram Director, Cancer Support Services RIVILEGED AND CONFIDENTIAL: This transmission may contain information hat is privileged subject to attorney-client privilege or attorney work roduct, confidential and/or exempt from disclosure under applicable aw. If you are not the intended recipient, then please do not read it nd be aware that any disclosure, copying, distribution, or use of the nformation contained herein (including any reliance thereon) is TRICTLY PROHIBITED. If you received this transmission in error, please mmediately advise me, by reply e-mail, and delete this message and any ttachments without retaining a copy in any form. Thank you. -----Original Message----- rom: PTManager [mailto:PTManager ] On ehalf Of Heidi Harmon ent: Wednesday, August 15, 2012 12:58 PM o: PTManager ubject: CPT Codes/Audits ello, I am looking for some input from someone who has been through a Medicare udit. As a clinic, we are trying to keep reimbursement as high as ossible while treating always one on one with our patients. Since nsurance reimbursement is not going up I am starting to evaluate the PT codes and their potential reimbursement. It seems Manual Therapy 97140) is one of the lowest reimbursed codes where as Therapeutic ctivities (97530), Neuromuscular Re-Education (97112) and Therapeutic xercise (97110) are the highest. We try everything we can to meet edicare requirements and guidelines. My questions are in an audit: 1. How closely are clinical notes and charges looked at? .. How strict do they hold to CPT code book definitions? .. Of the 3 best reimbursed CPT codes 97530, 97112, 97110 are there any hat fall under greater scrutiny? So my task is to get the exact definitions of the CPT codes (more than hat just the CPT code book defines) to provide to the therapist for ustification in their billing and find out if an audit that this is omething they really " dig " into. Thanks for any input anyone might have. Heidi illing Manager Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 15, 2012 Report Share Posted August 15, 2012 I have to agree with Ron. Even if the Therapists are requesting the information, it shouldn't change how they treat the patient. It is frustrating that manual therapy is on the low end of reimbursement. But also remember to look at the definitions of the cpt codes from your intermediary. For example, with WPS, make sure you are billing Rom and stretching as TE instead of manual therapy. This way you get paid for what you actually do based on their definitions. Just understanding what the cpt codes are to be used FOR, instead of looking at what pays the most, may boost your revenue. Of you want to learn more check out rick gawendas seminars. He is on here a lot as well and can probably shed more light on this for you. Regards, Priestap, PT Flint Michigan > I appreciate your response and would never tell a skilled PT what to code....just provide the education to them regarding the reimbursement of the codes....This is something they are requesting..not me. But thank you. > > RE: CPT Codes/Audits > > With all due respect, > rovision of skilled care is dictated by what the patient needs, not by > he code that brings a higher reimbursement. > E is TE , TA is TA, and so on. > he therapist is the one to determine and be responsible for the > ustification behind the use of the code/charge > he CPT code book provides the definition, and the skilled therapy > rovided must support its use, there is no wiggle room > Ron Barbato PT > dministrative Director, Rehabilitation Services > rogram Director, Cancer Support Services > > > RIVILEGED AND CONFIDENTIAL: This transmission may contain information > hat is privileged subject to attorney-client privilege or attorney work > roduct, confidential and/or exempt from disclosure under applicable > aw. If you are not the intended recipient, then please do not read it > nd be aware that any disclosure, copying, distribution, or use of the > nformation contained herein (including any reliance thereon) is > TRICTLY PROHIBITED. If you received this transmission in error, please > mmediately advise me, by reply e-mail, and delete this message and any > ttachments without retaining a copy in any form. Thank you. > -----Original Message----- > rom: PTManager [mailto:PTManager ] On > ehalf Of Heidi Harmon > ent: Wednesday, August 15, 2012 12:58 PM > o: PTManager > ubject: CPT Codes/Audits > > ello, > I am looking for some input from someone who has been through a Medicare > udit. As a clinic, we are trying to keep reimbursement as high as > ossible while treating always one on one with our patients. Since > nsurance reimbursement is not going up I am starting to evaluate the > PT codes and their potential reimbursement. It seems Manual Therapy > 97140) is one of the lowest reimbursed codes where as Therapeutic > ctivities (97530), Neuromuscular Re-Education (97112) and Therapeutic > xercise (97110) are the highest. We try everything we can to meet > edicare requirements and guidelines. > My questions are in an audit: > 1. How closely are clinical notes and charges looked at? > . How strict do they hold to CPT code book definitions? > . Of the 3 best reimbursed CPT codes 97530, 97112, 97110 are there any > hat fall under greater scrutiny? > So my task is to get the exact definitions of the CPT codes (more than > hat just the CPT code book defines) to provide to the therapist for > ustification in their billing and find out if an audit that this is > omething they really " dig " into. > Thanks for any input anyone might have. > Heidi > illing Manager > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 15, 2012 Report Share Posted August 15, 2012 I have been through 2 Medicare audits. The reason given for the audits was " overutilization of CPT code 97110. " However, this was never discussed as part of the audit. They looked to see if charges matched treatment duration, if POC's were written and signed within the guidelines; they considered biofeedback to be the primary treatment for incontinence and exercise was an adjunct therapy (we were cited for improper billing) and they looked at the content of chart notes. They will decline to pay for a visit if they do not like the documentation for that visit or if they feel the billing does not match the documentation. From: PTManager [mailto:PTManager ] On Behalf Of Heidi Harmon Sent: Wednesday, August 15, 2012 9:58 AM To: PTManager Subject: CPT Codes/Audits Hello, I am looking for some input from someone who has been through a Medicare audit. As a clinic, we are trying to keep reimbursement as high as possible while treating always one on one with our patients. Since insurance reimbursement is not going up I am starting to evaluate the CPT codes and their potential reimbursement. It seems Manual Therapy (97140) is one of the lowest reimbursed codes where as Therapeutic Activities (97530), Neuromuscular Re-Education (97112) and Therapeutic Exercise (97110) are the highest. We try everything we can to meet Medicare requirements and guidelines. My questions are in an audit: 1. How closely are clinical notes and charges looked at? 2. How strict do they hold to CPT code book definitions? 3. Of the 3 best reimbursed CPT codes 97530, 97112, 97110 are there any that fall under greater scrutiny? So my task is to get the exact definitions of the CPT codes (more than what just the CPT code book defines) to provide to the therapist for justification in their billing and find out if an audit that this is something they really " dig " into. Thanks for any input anyone might have. Heidi Billing Manager Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 15, 2012 Report Share Posted August 15, 2012 Great. Thanks . Unfortuanetly the CPT code books definitions of the codes seem vague and can be interpreted differently based on different pt's. Never would treatment be guided by the codes but if a timed code can actually be billed a higher reimbursing code, we should. But true definitions seem to be vague. Thanks for your help/guidance... Sent from my Verizon Wireless 4GLTE smartphone ----- Reply message ----- To: " PTManager " <PTManager > Subject: CPT Codes/Audits Date: Wed, Aug 15, 2012 5:15 pm I have to agree with Ron. Even if the Therapists are requesting the information, it shouldn't change how they treat the patient. It is frustrating that manual therapy is on the low end of reimbursement. But also remember to look at the definitions of the cpt codes from your intermediary. For example, with WPS, make sure you are billing Rom and stretching as TE instead of manual therapy. This way you get paid for what you actually do based on their definitions. Just understanding what the cpt codes are to be used FOR, instead of looking at what pays the most, may boost your revenue. Of you want to learn more check out rick gawendas seminars. He is on here a lot as well and can probably shed more light on this for you. Regards, Priestap, PT Flint Michigan > I appreciate your response and would never tell a skilled PT what to code....just provide the education to them regarding the reimbursement of the codes....This is something they are requesting..not me. But thank you. > > RE: CPT Codes/Audits > > With all due respect, > rovision of skilled care is dictated by what the patient needs, not by > he code that brings a higher reimbursement. > E is TE , TA is TA, and so on. > he therapist is the one to determine and be responsible for the > ustification behind the use of the code/charge > he CPT code book provides the definition, and the skilled therapy > rovided must support its use, there is no wiggle room > Ron Barbato PT > dministrative Director, Rehabilitation Services > rogram Director, Cancer Support Services > > > RIVILEGED AND CONFIDENTIAL: This transmission may contain information > hat is privileged subject to attorney-client privilege or attorney work > roduct, confidential and/or exempt from disclosure under applicable > aw. If you are not the intended recipient, then please do not read it > nd be aware that any disclosure, copying, distribution, or use of the > nformation contained herein (including any reliance thereon) is > TRICTLY PROHIBITED. If you received this transmission in error, please > mmediately advise me, by reply e-mail, and delete this message and any > ttachments without retaining a copy in any form. Thank you. > -----Original Message----- > rom: PTManager [mailto:PTManager ] On > ehalf Of Heidi Harmon > ent: Wednesday, August 15, 2012 12:58 PM > o: PTManager > ubject: CPT Codes/Audits > > ello, > I am looking for some input from someone who has been through a Medicare > udit. As a clinic, we are trying to keep reimbursement as high as > ossible while treating always one on one with our patients. Since > nsurance reimbursement is not going up I am starting to evaluate the > PT codes and their potential reimbursement. It seems Manual Therapy > 97140) is one of the lowest reimbursed codes where as Therapeutic > ctivities (97530), Neuromuscular Re-Education (97112) and Therapeutic > xercise (97110) are the highest. We try everything we can to meet > edicare requirements and guidelines. > My questions are in an audit: > 1. How closely are clinical notes and charges looked at? > . How strict do they hold to CPT code book definitions? > . Of the 3 best reimbursed CPT codes 97530, 97112, 97110 are there any > hat fall under greater scrutiny? > So my task is to get the exact definitions of the CPT codes (more than > hat just the CPT code book defines) to provide to the therapist for > ustification in their billing and find out if an audit that this is > omething they really " dig " into. > Thanks for any input anyone might have. > Heidi > illing Manager > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 15, 2012 Report Share Posted August 15, 2012 Great. Thanks . Unfortuanetly the CPT code books definitions of the codes seem vague and can be interpreted differently based on different pt's. Never would treatment be guided by the codes but if a timed code can actually be billed a higher reimbursing code, we should. But true definitions seem to be vague. Thanks for your help/guidance... Sent from my Verizon Wireless 4GLTE smartphone ----- Reply message ----- To: " PTManager " <PTManager > Subject: CPT Codes/Audits Date: Wed, Aug 15, 2012 5:15 pm I have to agree with Ron. Even if the Therapists are requesting the information, it shouldn't change how they treat the patient. It is frustrating that manual therapy is on the low end of reimbursement. But also remember to look at the definitions of the cpt codes from your intermediary. For example, with WPS, make sure you are billing Rom and stretching as TE instead of manual therapy. This way you get paid for what you actually do based on their definitions. Just understanding what the cpt codes are to be used FOR, instead of looking at what pays the most, may boost your revenue. Of you want to learn more check out rick gawendas seminars. He is on here a lot as well and can probably shed more light on this for you. Regards, Priestap, PT Flint Michigan > I appreciate your response and would never tell a skilled PT what to code....just provide the education to them regarding the reimbursement of the codes....This is something they are requesting..not me. But thank you. > > RE: CPT Codes/Audits > > With all due respect, > rovision of skilled care is dictated by what the patient needs, not by > he code that brings a higher reimbursement. > E is TE , TA is TA, and so on. > he therapist is the one to determine and be responsible for the > ustification behind the use of the code/charge > he CPT code book provides the definition, and the skilled therapy > rovided must support its use, there is no wiggle room > Ron Barbato PT > dministrative Director, Rehabilitation Services > rogram Director, Cancer Support Services > > > RIVILEGED AND CONFIDENTIAL: This transmission may contain information > hat is privileged subject to attorney-client privilege or attorney work > roduct, confidential and/or exempt from disclosure under applicable > aw. If you are not the intended recipient, then please do not read it > nd be aware that any disclosure, copying, distribution, or use of the > nformation contained herein (including any reliance thereon) is > TRICTLY PROHIBITED. If you received this transmission in error, please > mmediately advise me, by reply e-mail, and delete this message and any > ttachments without retaining a copy in any form. Thank you. > -----Original Message----- > rom: PTManager [mailto:PTManager ] On > ehalf Of Heidi Harmon > ent: Wednesday, August 15, 2012 12:58 PM > o: PTManager > ubject: CPT Codes/Audits > > ello, > I am looking for some input from someone who has been through a Medicare > udit. As a clinic, we are trying to keep reimbursement as high as > ossible while treating always one on one with our patients. Since > nsurance reimbursement is not going up I am starting to evaluate the > PT codes and their potential reimbursement. It seems Manual Therapy > 97140) is one of the lowest reimbursed codes where as Therapeutic > ctivities (97530), Neuromuscular Re-Education (97112) and Therapeutic > xercise (97110) are the highest. We try everything we can to meet > edicare requirements and guidelines. > My questions are in an audit: > 1. How closely are clinical notes and charges looked at? > . How strict do they hold to CPT code book definitions? > . Of the 3 best reimbursed CPT codes 97530, 97112, 97110 are there any > hat fall under greater scrutiny? > So my task is to get the exact definitions of the CPT codes (more than > hat just the CPT code book defines) to provide to the therapist for > ustification in their billing and find out if an audit that this is > omething they really " dig " into. > Thanks for any input anyone might have. > Heidi > illing Manager > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 16, 2012 Report Share Posted August 16, 2012 Ron, With all due respect, therapists, especially new ones, NEED educated on the codes as they really have no idea what they are coding most of the time and they tend to bill 97110 on just about everything. Under coding for services only benefits the payer. The Insurance gets the benefit of discounting our skilled services. I think posing this in terms of providing quality, highly skilled care and documenting this through proper documentation and charges may help the staff and reflects more of what we actually do vs. undercoding everything and billing it as 97110. Working. Better. Together Ric A. Baird, DPT, ATC www.interactiveptandfitness.com www.ipt.tsfl.com Interactive Physical Therapy and Fitness Center 3405 NW Hunters Ridge Terrace Suite 300 Topeka, KS 66618 (P) (F) Interactive Physical Therapy 1707 SE 29th Street Suites 300-400 Topeka, KS 66605 (P) (F) From: PTManager [mailto:PTManager ] On Behalf Of Ron Barbato Sent: Wednesday, August 15, 2012 2:59 PM To: PTManager Subject: RE: CPT Codes/Audits With all due respect, Provision of skilled care is dictated by what the patient needs, not by the code that brings a higher reimbursement. TE is TE , TA is TA, and so on. The therapist is the one to determine and be responsible for the justification behind the use of the code/charge The CPT code book provides the definition, and the skilled therapy provided must support its use, there is no wiggle room Ron Barbato PT Administrative Director, Rehabilitation Services Program Director, Cancer Support Services PRIVILEGED AND CONFIDENTIAL: This transmission may contain information that is privileged subject to attorney-client privilege or attorney work product, confidential and/or exempt from disclosure under applicable law. If you are not the intended recipient, then please do not read it and be aware that any disclosure, copying, distribution, or use of the information contained herein (including any reliance thereon) is STRICTLY PROHIBITED. If you received this transmission in error, please immediately advise me, by reply e-mail, and delete this message and any attachments without retaining a copy in any form. Thank you. CPT Codes/Audits Hello, I am looking for some input from someone who has been through a Medicare audit. As a clinic, we are trying to keep reimbursement as high as possible while treating always one on one with our patients. Since insurance reimbursement is not going up I am starting to evaluate the CPT codes and their potential reimbursement. It seems Manual Therapy (97140) is one of the lowest reimbursed codes where as Therapeutic Activities (97530), Neuromuscular Re-Education (97112) and Therapeutic Exercise (97110) are the highest. We try everything we can to meet Medicare requirements and guidelines. My questions are in an audit: 1. How closely are clinical notes and charges looked at? 2. How strict do they hold to CPT code book definitions? 3. Of the 3 best reimbursed CPT codes 97530, 97112, 97110 are there any that fall under greater scrutiny? So my task is to get the exact definitions of the CPT codes (more than what just the CPT code book defines) to provide to the therapist for justification in their billing and find out if an audit that this is something they really " dig " into. Thanks for any input anyone might have. Heidi Billing Manager Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 16, 2012 Report Share Posted August 16, 2012 Ron, With all due respect, therapists, especially new ones, NEED educated on the codes as they really have no idea what they are coding most of the time and they tend to bill 97110 on just about everything. Under coding for services only benefits the payer. The Insurance gets the benefit of discounting our skilled services. I think posing this in terms of providing quality, highly skilled care and documenting this through proper documentation and charges may help the staff and reflects more of what we actually do vs. undercoding everything and billing it as 97110. Working. Better. Together Ric A. Baird, DPT, ATC www.interactiveptandfitness.com www.ipt.tsfl.com Interactive Physical Therapy and Fitness Center 3405 NW Hunters Ridge Terrace Suite 300 Topeka, KS 66618 (P) (F) Interactive Physical Therapy 1707 SE 29th Street Suites 300-400 Topeka, KS 66605 (P) (F) From: PTManager [mailto:PTManager ] On Behalf Of Ron Barbato Sent: Wednesday, August 15, 2012 2:59 PM To: PTManager Subject: RE: CPT Codes/Audits With all due respect, Provision of skilled care is dictated by what the patient needs, not by the code that brings a higher reimbursement. TE is TE , TA is TA, and so on. The therapist is the one to determine and be responsible for the justification behind the use of the code/charge The CPT code book provides the definition, and the skilled therapy provided must support its use, there is no wiggle room Ron Barbato PT Administrative Director, Rehabilitation Services Program Director, Cancer Support Services PRIVILEGED AND CONFIDENTIAL: This transmission may contain information that is privileged subject to attorney-client privilege or attorney work product, confidential and/or exempt from disclosure under applicable law. If you are not the intended recipient, then please do not read it and be aware that any disclosure, copying, distribution, or use of the information contained herein (including any reliance thereon) is STRICTLY PROHIBITED. If you received this transmission in error, please immediately advise me, by reply e-mail, and delete this message and any attachments without retaining a copy in any form. Thank you. CPT Codes/Audits Hello, I am looking for some input from someone who has been through a Medicare audit. As a clinic, we are trying to keep reimbursement as high as possible while treating always one on one with our patients. Since insurance reimbursement is not going up I am starting to evaluate the CPT codes and their potential reimbursement. It seems Manual Therapy (97140) is one of the lowest reimbursed codes where as Therapeutic Activities (97530), Neuromuscular Re-Education (97112) and Therapeutic Exercise (97110) are the highest. We try everything we can to meet Medicare requirements and guidelines. My questions are in an audit: 1. How closely are clinical notes and charges looked at? 2. How strict do they hold to CPT code book definitions? 3. Of the 3 best reimbursed CPT codes 97530, 97112, 97110 are there any that fall under greater scrutiny? So my task is to get the exact definitions of the CPT codes (more than what just the CPT code book defines) to provide to the therapist for justification in their billing and find out if an audit that this is something they really " dig " into. Thanks for any input anyone might have. Heidi Billing Manager Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 16, 2012 Report Share Posted August 16, 2012 Well said Ric, and I agree, after 30+ years I still get confused . Perhaps this was the intent of the original post, and although unclear in my post , my response was directed at the three questions posted. Having spent the last 9 years in the regulatory world as an investigator , Medicare examiner and auditor I have seen first hand the abuse of the reimbursement system. Ron Barbato PT ________________________________ From: PTManager on behalf of Ric Baird Sent: Thu 8/16/2012 8:16 AM To: PTManager Subject: RE: CPT Codes/Audits Ron, With all due respect, therapists, especially new ones, NEED educated on the codes as they really have no idea what they are coding most of the time and they tend to bill 97110 on just about everything. Under coding for services only benefits the payer. The Insurance gets the benefit of discounting our skilled services. I think posing this in terms of providing quality, highly skilled care and documenting this through proper documentation and charges may help the staff and reflects more of what we actually do vs. undercoding everything and billing it as 97110. Working. Better. Together Ric A. Baird, DPT, ATC www.interactiveptandfitness.com www.ipt.tsfl.com Interactive Physical Therapy and Fitness Center 3405 NW Hunters Ridge Terrace Suite 300 Topeka, KS 66618 (P) (F) Interactive Physical Therapy 1707 SE 29th Street Suites 300-400 Topeka, KS 66605 (P) (F) From: PTManager [mailto:PTManager ] On Behalf Of Ron Barbato Sent: Wednesday, August 15, 2012 2:59 PM To: PTManager Subject: RE: CPT Codes/Audits With all due respect, Provision of skilled care is dictated by what the patient needs, not by the code that brings a higher reimbursement. TE is TE , TA is TA, and so on. The therapist is the one to determine and be responsible for the justification behind the use of the code/charge The CPT code book provides the definition, and the skilled therapy provided must support its use, there is no wiggle room Ron Barbato PT Administrative Director, Rehabilitation Services Program Director, Cancer Support Services PRIVILEGED AND CONFIDENTIAL: This transmission may contain information that is privileged subject to attorney-client privilege or attorney work product, confidential and/or exempt from disclosure under applicable law. If you are not the intended recipient, then please do not read it and be aware that any disclosure, copying, distribution, or use of the information contained herein (including any reliance thereon) is STRICTLY PROHIBITED. If you received this transmission in error, please immediately advise me, by reply e-mail, and delete this message and any attachments without retaining a copy in any form. Thank you. CPT Codes/Audits Hello, I am looking for some input from someone who has been through a Medicare audit. As a clinic, we are trying to keep reimbursement as high as possible while treating always one on one with our patients. Since insurance reimbursement is not going up I am starting to evaluate the CPT codes and their potential reimbursement. It seems Manual Therapy (97140) is one of the lowest reimbursed codes where as Therapeutic Activities (97530), Neuromuscular Re-Education (97112) and Therapeutic Exercise (97110) are the highest. We try everything we can to meet Medicare requirements and guidelines. My questions are in an audit: 1. How closely are clinical notes and charges looked at? 2. How strict do they hold to CPT code book definitions? 3. Of the 3 best reimbursed CPT codes 97530, 97112, 97110 are there any that fall under greater scrutiny? So my task is to get the exact definitions of the CPT codes (more than what just the CPT code book defines) to provide to the therapist for justification in their billing and find out if an audit that this is something they really " dig " into. Thanks for any input anyone might have. Heidi Billing Manager Quote Link to comment Share on other sites More sharing options...
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