Guest guest Posted August 19, 2012 Report Share Posted August 19, 2012 Hi everyone, Although I know many clinics do not do this, I had a question regarding having a Medicare patient and a private insurance patient in the clinic at the same time and whether a group code has to be used and why. I could not explain it well enough to the questioner so I wanted to get help from the group. Thanks! M.Howell, P.T., M.P.T. IPTA Payment Specialist Meridian, Idaho thowell@... This email and any files transmitted with it may contain PRIVILEGED or CONFIDENTIAL information and may be read or used only by the intended recipient. If you are not the intended recipient of the email or any of its attachments, please be advised that you have received this email in error and that any use, dissemination, distribution, forwarding, printing or copying of this email or any attached files is strictly prohibited. If you have received this email in error, please immediately purge it and all attachments and notify the sender by reply email. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 20, 2012 Report Share Posted August 20, 2012 Hi, tom - Great question! It traces back to HIPAA, in my view: There may be only one code set, the AMA's CPT Codes, used for health care insurance billing nationwide. The CPT Code instructions at the front of the book says to use the code which *exactly describes* the service being provided, *not* the one which comes closest. Therefore, the one-to-one codes apply to all patients, not just Medicare. One Medicare and one Brand-X Insurance equals more than one, so neither of them may be described as being alone with the therapist. Warmest regards, Dick Hillyer Dr. Hillyer Hillyer Consulting Cape Coral, FL 33914 _____ From: PTManager [mailto:PTManager ] On Behalf Of M. Howell PT, MPT Sent: Monday, August 20, 2012 12:13 AM To: PTManager Subject: Group therapy question Hi everyone, Although I know many clinics do not do this, I had a question regarding having a Medicare patient and a private insurance patient in the clinic at the same time and whether a group code has to be used and why. I could not explain it well enough to the questioner so I wanted to get help from the group. Thanks! M.Howell, P.T., M.P.T. IPTA Payment Specialist Meridian, Idaho thowell@... <mailto:thowell%40fiberpipe.net> This email and any files transmitted with it may contain PRIVILEGED or CONFIDENTIAL information and may be read or used only by the intended recipient. If you are not the intended recipient of the email or any of its attachments, please be advised that you have received this email in error and that any use, dissemination, distribution, forwarding, printing or copying of this email or any attached files is strictly prohibited. If you have received this email in error, please immediately purge it and all attachments and notify the sender by reply email. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 20, 2012 Report Share Posted August 20, 2012 Hi, tom - Great question! It traces back to HIPAA, in my view: There may be only one code set, the AMA's CPT Codes, used for health care insurance billing nationwide. The CPT Code instructions at the front of the book says to use the code which *exactly describes* the service being provided, *not* the one which comes closest. Therefore, the one-to-one codes apply to all patients, not just Medicare. One Medicare and one Brand-X Insurance equals more than one, so neither of them may be described as being alone with the therapist. Warmest regards, Dick Hillyer Dr. Hillyer Hillyer Consulting Cape Coral, FL 33914 _____ From: PTManager [mailto:PTManager ] On Behalf Of M. Howell PT, MPT Sent: Monday, August 20, 2012 12:13 AM To: PTManager Subject: Group therapy question Hi everyone, Although I know many clinics do not do this, I had a question regarding having a Medicare patient and a private insurance patient in the clinic at the same time and whether a group code has to be used and why. I could not explain it well enough to the questioner so I wanted to get help from the group. Thanks! M.Howell, P.T., M.P.T. IPTA Payment Specialist Meridian, Idaho thowell@... <mailto:thowell%40fiberpipe.net> This email and any files transmitted with it may contain PRIVILEGED or CONFIDENTIAL information and may be read or used only by the intended recipient. If you are not the intended recipient of the email or any of its attachments, please be advised that you have received this email in error and that any use, dissemination, distribution, forwarding, printing or copying of this email or any attached files is strictly prohibited. If you have received this email in error, please immediately purge it and all attachments and notify the sender by reply email. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 20, 2012 Report Share Posted August 20, 2012 Hi, tom - Great question! It traces back to HIPAA, in my view: There may be only one code set, the AMA's CPT Codes, used for health care insurance billing nationwide. The CPT Code instructions at the front of the book says to use the code which *exactly describes* the service being provided, *not* the one which comes closest. Therefore, the one-to-one codes apply to all patients, not just Medicare. One Medicare and one Brand-X Insurance equals more than one, so neither of them may be described as being alone with the therapist. Warmest regards, Dick Hillyer Dr. Hillyer Hillyer Consulting Cape Coral, FL 33914 _____ From: PTManager [mailto:PTManager ] On Behalf Of M. Howell PT, MPT Sent: Monday, August 20, 2012 12:13 AM To: PTManager Subject: Group therapy question Hi everyone, Although I know many clinics do not do this, I had a question regarding having a Medicare patient and a private insurance patient in the clinic at the same time and whether a group code has to be used and why. I could not explain it well enough to the questioner so I wanted to get help from the group. Thanks! M.Howell, P.T., M.P.T. IPTA Payment Specialist Meridian, Idaho thowell@... <mailto:thowell%40fiberpipe.net> This email and any files transmitted with it may contain PRIVILEGED or CONFIDENTIAL information and may be read or used only by the intended recipient. If you are not the intended recipient of the email or any of its attachments, please be advised that you have received this email in error and that any use, dissemination, distribution, forwarding, printing or copying of this email or any attached files is strictly prohibited. If you have received this email in error, please immediately purge it and all attachments and notify the sender by reply email. Quote Link to comment Share on other sites More sharing options...
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