RE: Treating with multiple therapists

[Guest guest]

I just got denied payment in a RAC audit for the exact same situation. In

that case I was a med B provider and the other clinic was a CORF billing as

a part A, as well as a hospital based clinic billing as part A. However I

am now hesitant to do the same if both were part B.

Odilia Egbers, PT

Springfield, MO

> I just got denied payment in a RAC audit for the exact same situation. In

> that case I was a med B provider and the other clinic was a CORF billing as

> a part A, as well as a hospital based clinic billing as part A. However I

> am now hesitant to do the same if both were part B.

>

> Odilia Egbers, PT

> Springfield, MO

>

>

> On Sun, Aug 26, 2012 at 9:46 PM, Gabe Freyaldenhoven <

> gabe@...> wrote:

>

>> **

>>

>>

>> We have a unique situation in our clinic I'd like to get the groups

>> thoughts

>> on. We have a patient that has dealt with lower extremity lymphedema for a

>> number of years and in recent history has been able to manage this at

>> home.

>> We have been seeing him for the last month after a recent functional

>> decline

>> for gait training, balance training, and strengthening to help him regain

>> his function. He was ill two weeks ago(flu) and was immobile for a couple

>> of days, which exacerbated his lymphedema. We have a therapist in our

>> community that he has seen previously that he wishes to see for his

>> lymphedema, but wants us to continue working with him on his gait and

>> balance.

>>

>> We have a staff member that could provide the lymphedema treatment, but he

>> wants to return to his previous therapist for this. I've talked to him

>> about her doing his gait and balance training as well, but he refuses to

>> do

>> this with her because of a previous poor experience. In trying to respect

>> his wishes, I was thinking about 'tag-teaming' the treatment with this

>> other

>> therapist by having her perform(and bill) for the manual aspect of his

>> lymphedema treatment and scheduling his treatment with us immediately

>> afterwards to address with gait and balance deficits.

>>

>> My question is, if we use distinct ICD codes, have distinctly different

>> goals, and don't overlap treatment, can we both see and bill the patient

>> in

>> this type of 'co-treatment' on the same date of service. The patient has

>> Medicare and my clinic is a private practice while the other therapist is

>> hospital based.

>>

>> I realize the simple thing would be for one clinic to do the complete

>> treatment, but so far the patient has resisted this.

>>

>> Thanks for your input,

>>

>> Gabe Freyaldenhoven, PT

>>

>> River Valley Therapy and Sports Medicine

>>

>>

[Guest guest]

I just got denied payment in a RAC audit for the exact same situation. In

that case I was a med B provider and the other clinic was a CORF billing as

a part A, as well as a hospital based clinic billing as part A. However I

am now hesitant to do the same if both were part B.

Odilia Egbers, PT

Springfield, MO

> I just got denied payment in a RAC audit for the exact same situation. In

> that case I was a med B provider and the other clinic was a CORF billing as

> a part A, as well as a hospital based clinic billing as part A. However I

> am now hesitant to do the same if both were part B.

>

> Odilia Egbers, PT

> Springfield, MO

>

>

> On Sun, Aug 26, 2012 at 9:46 PM, Gabe Freyaldenhoven <

> gabe@...> wrote:

>

>> **

>>

>>

>> We have a unique situation in our clinic I'd like to get the groups

>> thoughts

>> on. We have a patient that has dealt with lower extremity lymphedema for a

>> number of years and in recent history has been able to manage this at

>> home.

>> We have been seeing him for the last month after a recent functional

>> decline

>> for gait training, balance training, and strengthening to help him regain

>> his function. He was ill two weeks ago(flu) and was immobile for a couple

>> of days, which exacerbated his lymphedema. We have a therapist in our

>> community that he has seen previously that he wishes to see for his

>> lymphedema, but wants us to continue working with him on his gait and

>> balance.

>>

>> We have a staff member that could provide the lymphedema treatment, but he

>> wants to return to his previous therapist for this. I've talked to him

>> about her doing his gait and balance training as well, but he refuses to

>> do

>> this with her because of a previous poor experience. In trying to respect

>> his wishes, I was thinking about 'tag-teaming' the treatment with this

>> other

>> therapist by having her perform(and bill) for the manual aspect of his

>> lymphedema treatment and scheduling his treatment with us immediately

>> afterwards to address with gait and balance deficits.

>>

>> My question is, if we use distinct ICD codes, have distinctly different

>> goals, and don't overlap treatment, can we both see and bill the patient

>> in

>> this type of 'co-treatment' on the same date of service. The patient has

>> Medicare and my clinic is a private practice while the other therapist is

>> hospital based.

>>

>> I realize the simple thing would be for one clinic to do the complete

>> treatment, but so far the patient has resisted this.

>>

>> Thanks for your input,

>>

>> Gabe Freyaldenhoven, PT

>>

>> River Valley Therapy and Sports Medicine

>>

>>

[Guest guest]

I just got denied payment in a RAC audit for the exact same situation. In

that case I was a med B provider and the other clinic was a CORF billing as

a part A, as well as a hospital based clinic billing as part A. However I

am now hesitant to do the same if both were part B.

Odilia Egbers, PT

Springfield, MO

> I just got denied payment in a RAC audit for the exact same situation. In

> that case I was a med B provider and the other clinic was a CORF billing as

> a part A, as well as a hospital based clinic billing as part A. However I

> am now hesitant to do the same if both were part B.

>

> Odilia Egbers, PT

> Springfield, MO

>

>

> On Sun, Aug 26, 2012 at 9:46 PM, Gabe Freyaldenhoven <

> gabe@...> wrote:

>

>> **

>>

>>

>> We have a unique situation in our clinic I'd like to get the groups

>> thoughts

>> on. We have a patient that has dealt with lower extremity lymphedema for a

>> number of years and in recent history has been able to manage this at

>> home.

>> We have been seeing him for the last month after a recent functional

>> decline

>> for gait training, balance training, and strengthening to help him regain

>> his function. He was ill two weeks ago(flu) and was immobile for a couple

>> of days, which exacerbated his lymphedema. We have a therapist in our

>> community that he has seen previously that he wishes to see for his

>> lymphedema, but wants us to continue working with him on his gait and

>> balance.

>>

>> We have a staff member that could provide the lymphedema treatment, but he

>> wants to return to his previous therapist for this. I've talked to him

>> about her doing his gait and balance training as well, but he refuses to

>> do

>> this with her because of a previous poor experience. In trying to respect

>> his wishes, I was thinking about 'tag-teaming' the treatment with this

>> other

>> therapist by having her perform(and bill) for the manual aspect of his

>> lymphedema treatment and scheduling his treatment with us immediately

>> afterwards to address with gait and balance deficits.

>>

>> My question is, if we use distinct ICD codes, have distinctly different

>> goals, and don't overlap treatment, can we both see and bill the patient

>> in

>> this type of 'co-treatment' on the same date of service. The patient has

>> Medicare and my clinic is a private practice while the other therapist is

>> hospital based.

>>

>> I realize the simple thing would be for one clinic to do the complete

>> treatment, but so far the patient has resisted this.

>>

>> Thanks for your input,

>>

>> Gabe Freyaldenhoven, PT

>>

>> River Valley Therapy and Sports Medicine

>>

>>

[Guest guest]

I don't see an issue, each therapist has respective " expertise " Not

any different than the patients who seek specialists for any other care.

My concern would be payment, especially if the visits occur on the same

day . Perhaps clear it with his intermediary first?

Ron Barbato PT

Administrative Director, Rehabilitation Services

Program Director, Cancer Support Services

Ephraim McDowell Health

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.

Treating with multiple therapists

We have a unique situation in our clinic I'd like to get the groups

thoughts

on. We have a patient that has dealt with lower extremity lymphedema

for a

number of years and in recent history has been able to manage this at

home.

We have been seeing him for the last month after a recent functional

decline

for gait training, balance training, and strengthening to help him

regain

his function. He was ill two weeks ago(flu) and was immobile for a

couple

of days, which exacerbated his lymphedema. We have a therapist in our

community that he has seen previously that he wishes to see for his

lymphedema, but wants us to continue working with him on his gait and

balance.

We have a staff member that could provide the lymphedema treatment, but

he

wants to return to his previous therapist for this. I've talked to him

about her doing his gait and balance training as well, but he refuses to

do

this with her because of a previous poor experience. In trying to

respect

his wishes, I was thinking about 'tag-teaming' the treatment with this

other

therapist by having her perform(and bill) for the manual aspect of his

lymphedema treatment and scheduling his treatment with us immediately

afterwards to address with gait and balance deficits.

My question is, if we use distinct ICD codes, have distinctly different

goals, and don't overlap treatment, can we both see and bill the patient

in

this type of 'co-treatment' on the same date of service. The patient

has

Medicare and my clinic is a private practice while the other therapist

is

hospital based.

I realize the simple thing would be for one clinic to do the complete

treatment, but so far the patient has resisted this.

Thanks for your input,

Gabe Freyaldenhoven, PT

River Valley Therapy and Sports Medicine

[Guest guest]

Odelia

Please clarify: I am assuming that you received a RAC denial because if

services were provided on the same date (you, CORF, Hospital), and if an

untimed code was billed by more than one provider on the same date,

triggering the RAC issue (for example unattended estim). Can you please

clarify that, as " untimed codes billed in units greater than one " has been a

posted RAC issues by all 4 regional RACs as an automated review issue.

Records are not requested or reviewed on automated issues, but rather coding

edits are in place that trigger the demand letter for payment.

The RAC review caught this as they look at the beneficiary's claims, not

Part A or Part B in isolation - that is part of their proprietary data

mining and predictive modeling that is in use.

J. Beckley, MS, MBA, CHC | President

Beckley & Associates LLC

P | F

<http://nancybeckley.com/> nancybeckley.com |

<http://rehabcomplianceblog.com/> rehabcomplianceblog.com

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<http://www.linkedin.com/in/nancybeckley> Description: Description:

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From: PTManager [mailto:PTManager ] On Behalf

Of Odilia Egbers

Sent: Monday, August 27, 2012 9:05 AM

To: PTManager

Subject: Re: Treating with multiple therapists

I just got denied payment in a RAC audit for the exact same situation. In

that case I was a med B provider and the other clinic was a CORF billing as

a part A, as well as a hospital based clinic billing as part A. However I

am now hesitant to do the same if both were part B.

Odilia Egbers, PT

Springfield, MO

On Mon, Aug 27, 2012 at 9:04 AM, Odilia Egbers <odilia1973@...

<mailto:odilia1973%40gmail.com> > wrote:

> I just got denied payment in a RAC audit for the exact same situation. In

> that case I was a med B provider and the other clinic was a CORF billing

as

> a part A, as well as a hospital based clinic billing as part A. However I

> am now hesitant to do the same if both were part B.

>

> Odilia Egbers, PT

> Springfield, MO

>

>

> On Sun, Aug 26, 2012 at 9:46 PM, Gabe Freyaldenhoven <

> gabe@... <mailto:gabe%40rivervalleytherapy.com> >

wrote:

>

>> **

>>

>>

>> We have a unique situation in our clinic I'd like to get the groups

>> thoughts

>> on. We have a patient that has dealt with lower extremity lymphedema for

a

>> number of years and in recent history has been able to manage this at

>> home.

>> We have been seeing him for the last month after a recent functional

>> decline

>> for gait training, balance training, and strengthening to help him regain

>> his function. He was ill two weeks ago(flu) and was immobile for a couple

>> of days, which exacerbated his lymphedema. We have a therapist in our

>> community that he has seen previously that he wishes to see for his

>> lymphedema, but wants us to continue working with him on his gait and

>> balance.

>>

>> We have a staff member that could provide the lymphedema treatment, but

he

>> wants to return to his previous therapist for this. I've talked to him

>> about her doing his gait and balance training as well, but he refuses to

>> do

>> this with her because of a previous poor experience. In trying to respect

>> his wishes, I was thinking about 'tag-teaming' the treatment with this

>> other

>> therapist by having her perform(and bill) for the manual aspect of his

>> lymphedema treatment and scheduling his treatment with us immediately

>> afterwards to address with gait and balance deficits.

>>

>> My question is, if we use distinct ICD codes, have distinctly different

>> goals, and don't overlap treatment, can we both see and bill the patient

>> in

>> this type of 'co-treatment' on the same date of service. The patient has

>> Medicare and my clinic is a private practice while the other therapist is

>> hospital based.

>>

>> I realize the simple thing would be for one clinic to do the complete

>> treatment, but so far the patient has resisted this.

>>

>> Thanks for your input,

>>

>> Gabe Freyaldenhoven, PT

>>

>> River Valley Therapy and Sports Medicine

>>

>>

[Guest guest]

Odelia

Please clarify: I am assuming that you received a RAC denial because if

services were provided on the same date (you, CORF, Hospital), and if an

untimed code was billed by more than one provider on the same date,

triggering the RAC issue (for example unattended estim). Can you please

clarify that, as " untimed codes billed in units greater than one " has been a

posted RAC issues by all 4 regional RACs as an automated review issue.

Records are not requested or reviewed on automated issues, but rather coding

edits are in place that trigger the demand letter for payment.

The RAC review caught this as they look at the beneficiary's claims, not

Part A or Part B in isolation - that is part of their proprietary data

mining and predictive modeling that is in use.

J. Beckley, MS, MBA, CHC | President

Beckley & Associates LLC

P | F

<http://nancybeckley.com/> nancybeckley.com |

<http://rehabcomplianceblog.com/> rehabcomplianceblog.com

<http://nancybeckley.com/> Description: Description: Description: Logo for

email signature3

<http://www.linkedin.com/in/nancybeckley> Description: Description:

ZA102637857 Linked In Icon <http://www.twitter.com/nancybeckley>

Description: Description: ZA102637858 Twitter Icon

From: PTManager [mailto:PTManager ] On Behalf

Of Odilia Egbers

Sent: Monday, August 27, 2012 9:05 AM

To: PTManager

Subject: Re: Treating with multiple therapists

I just got denied payment in a RAC audit for the exact same situation. In

that case I was a med B provider and the other clinic was a CORF billing as

a part A, as well as a hospital based clinic billing as part A. However I

am now hesitant to do the same if both were part B.

Odilia Egbers, PT

Springfield, MO

On Mon, Aug 27, 2012 at 9:04 AM, Odilia Egbers <odilia1973@...

<mailto:odilia1973%40gmail.com> > wrote:

> I just got denied payment in a RAC audit for the exact same situation. In

> that case I was a med B provider and the other clinic was a CORF billing

as

> a part A, as well as a hospital based clinic billing as part A. However I

> am now hesitant to do the same if both were part B.

>

> Odilia Egbers, PT

> Springfield, MO

>

>

> On Sun, Aug 26, 2012 at 9:46 PM, Gabe Freyaldenhoven <

> gabe@... <mailto:gabe%40rivervalleytherapy.com> >

wrote:

>

>> **

>>

>>

>> We have a unique situation in our clinic I'd like to get the groups

>> thoughts

>> on. We have a patient that has dealt with lower extremity lymphedema for

a

>> number of years and in recent history has been able to manage this at

>> home.

>> We have been seeing him for the last month after a recent functional

>> decline

>> for gait training, balance training, and strengthening to help him regain

>> his function. He was ill two weeks ago(flu) and was immobile for a couple

>> of days, which exacerbated his lymphedema. We have a therapist in our

>> community that he has seen previously that he wishes to see for his

>> lymphedema, but wants us to continue working with him on his gait and

>> balance.

>>

>> We have a staff member that could provide the lymphedema treatment, but

he

>> wants to return to his previous therapist for this. I've talked to him

>> about her doing his gait and balance training as well, but he refuses to

>> do

>> this with her because of a previous poor experience. In trying to respect

>> his wishes, I was thinking about 'tag-teaming' the treatment with this

>> other

>> therapist by having her perform(and bill) for the manual aspect of his

>> lymphedema treatment and scheduling his treatment with us immediately

>> afterwards to address with gait and balance deficits.

>>

>> My question is, if we use distinct ICD codes, have distinctly different

>> goals, and don't overlap treatment, can we both see and bill the patient

>> in

>> this type of 'co-treatment' on the same date of service. The patient has

>> Medicare and my clinic is a private practice while the other therapist is

>> hospital based.

>>

>> I realize the simple thing would be for one clinic to do the complete

>> treatment, but so far the patient has resisted this.

>>

>> Thanks for your input,

>>

>> Gabe Freyaldenhoven, PT

>>

>> River Valley Therapy and Sports Medicine

>>

>>

[Guest guest]

Odelia

Please clarify: I am assuming that you received a RAC denial because if

services were provided on the same date (you, CORF, Hospital), and if an

untimed code was billed by more than one provider on the same date,

triggering the RAC issue (for example unattended estim). Can you please

clarify that, as " untimed codes billed in units greater than one " has been a

posted RAC issues by all 4 regional RACs as an automated review issue.

Records are not requested or reviewed on automated issues, but rather coding

edits are in place that trigger the demand letter for payment.

The RAC review caught this as they look at the beneficiary's claims, not

Part A or Part B in isolation - that is part of their proprietary data

mining and predictive modeling that is in use.

J. Beckley, MS, MBA, CHC | President

Beckley & Associates LLC

P | F

<http://nancybeckley.com/> nancybeckley.com |

<http://rehabcomplianceblog.com/> rehabcomplianceblog.com

<http://nancybeckley.com/> Description: Description: Description: Logo for

email signature3

<http://www.linkedin.com/in/nancybeckley> Description: Description:

ZA102637857 Linked In Icon <http://www.twitter.com/nancybeckley>

Description: Description: ZA102637858 Twitter Icon

From: PTManager [mailto:PTManager ] On Behalf

Of Odilia Egbers

Sent: Monday, August 27, 2012 9:05 AM

To: PTManager

Subject: Re: Treating with multiple therapists

I just got denied payment in a RAC audit for the exact same situation. In

that case I was a med B provider and the other clinic was a CORF billing as

a part A, as well as a hospital based clinic billing as part A. However I

am now hesitant to do the same if both were part B.

Odilia Egbers, PT

Springfield, MO

On Mon, Aug 27, 2012 at 9:04 AM, Odilia Egbers <odilia1973@...

<mailto:odilia1973%40gmail.com> > wrote:

> I just got denied payment in a RAC audit for the exact same situation. In

> that case I was a med B provider and the other clinic was a CORF billing

as

> a part A, as well as a hospital based clinic billing as part A. However I

> am now hesitant to do the same if both were part B.

>

> Odilia Egbers, PT

> Springfield, MO

>

>

> On Sun, Aug 26, 2012 at 9:46 PM, Gabe Freyaldenhoven <

> gabe@... <mailto:gabe%40rivervalleytherapy.com> >

wrote:

>

>> **

>>

>>

>> We have a unique situation in our clinic I'd like to get the groups

>> thoughts

>> on. We have a patient that has dealt with lower extremity lymphedema for

a

>> number of years and in recent history has been able to manage this at

>> home.

>> We have been seeing him for the last month after a recent functional

>> decline

>> for gait training, balance training, and strengthening to help him regain

>> his function. He was ill two weeks ago(flu) and was immobile for a couple

>> of days, which exacerbated his lymphedema. We have a therapist in our

>> community that he has seen previously that he wishes to see for his

>> lymphedema, but wants us to continue working with him on his gait and

>> balance.

>>

>> We have a staff member that could provide the lymphedema treatment, but

he

>> wants to return to his previous therapist for this. I've talked to him

>> about her doing his gait and balance training as well, but he refuses to

>> do

>> this with her because of a previous poor experience. In trying to respect

>> his wishes, I was thinking about 'tag-teaming' the treatment with this

>> other

>> therapist by having her perform(and bill) for the manual aspect of his

>> lymphedema treatment and scheduling his treatment with us immediately

>> afterwards to address with gait and balance deficits.

>>

>> My question is, if we use distinct ICD codes, have distinctly different

>> goals, and don't overlap treatment, can we both see and bill the patient

>> in

>> this type of 'co-treatment' on the same date of service. The patient has

>> Medicare and my clinic is a private practice while the other therapist is

>> hospital based.

>>

>> I realize the simple thing would be for one clinic to do the complete

>> treatment, but so far the patient has resisted this.

>>

>> Thanks for your input,

>>

>> Gabe Freyaldenhoven, PT

>>

>> River Valley Therapy and Sports Medicine

>>

>>

[Guest guest]

The issue is payment if the patient sees the 2 therapists on the same date of

service. Most likely, one claim will get reimbursed (first in) and the second

(last in) will not be reimbursed. No sense in clearing it with the Medicare

contractor since the claims are submitted electronically and no one is

physically looking at the claims.

Rick Gawenda, PT

President

Gawenda Seminars & Consulting, Inc.

Medicare Therapy Cap & Manual Medical Review Process Webinar

https://www.showmyevent.com/events/viewEventDetails.aspx?EventID=1992

Subject: RE: Treating with multiple therapists

To: PTManager

Date: Monday, August 27, 2012, 10:45 AM

 

I don't see an issue, each therapist has respective " expertise " Not

any different than the patients who seek specialists for any other care.

My concern would be payment, especially if the visits occur on the same

day . Perhaps clear it with his intermediary first?

Ron Barbato PT

Administrative Director, Rehabilitation Services

Program Director, Cancer Support Services

Ephraim McDowell Health

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.

Treating with multiple therapists

We have a unique situation in our clinic I'd like to get the groups

thoughts

on. We have a patient that has dealt with lower extremity lymphedema

for a

number of years and in recent history has been able to manage this at

home.

We have been seeing him for the last month after a recent functional

decline

for gait training, balance training, and strengthening to help him

regain

his function. He was ill two weeks ago(flu) and was immobile for a

couple

of days, which exacerbated his lymphedema. We have a therapist in our

community that he has seen previously that he wishes to see for his

lymphedema, but wants us to continue working with him on his gait and

balance.

We have a staff member that could provide the lymphedema treatment, but

he

wants to return to his previous therapist for this. I've talked to him

about her doing his gait and balance training as well, but he refuses to

do

this with her because of a previous poor experience. In trying to

respect

his wishes, I was thinking about 'tag-teaming' the treatment with this

other

therapist by having her perform(and bill) for the manual aspect of his

lymphedema treatment and scheduling his treatment with us immediately

afterwards to address with gait and balance deficits.

My question is, if we use distinct ICD codes, have distinctly different

goals, and don't overlap treatment, can we both see and bill the patient

in

this type of 'co-treatment' on the same date of service. The patient

has

Medicare and my clinic is a private practice while the other therapist

is

hospital based.

I realize the simple thing would be for one clinic to do the complete

treatment, but so far the patient has resisted this.

Thanks for your input,

Gabe Freyaldenhoven, PT

River Valley Therapy and Sports Medicine

[Guest guest]

The issue is payment if the patient sees the 2 therapists on the same date of

service. Most likely, one claim will get reimbursed (first in) and the second

(last in) will not be reimbursed. No sense in clearing it with the Medicare

contractor since the claims are submitted electronically and no one is

physically looking at the claims.

Rick Gawenda, PT

President

Gawenda Seminars & Consulting, Inc.

Medicare Therapy Cap & Manual Medical Review Process Webinar

https://www.showmyevent.com/events/viewEventDetails.aspx?EventID=1992

Subject: RE: Treating with multiple therapists

To: PTManager

Date: Monday, August 27, 2012, 10:45 AM

 

I don't see an issue, each therapist has respective " expertise " Not

any different than the patients who seek specialists for any other care.

My concern would be payment, especially if the visits occur on the same

day . Perhaps clear it with his intermediary first?

Ron Barbato PT

Administrative Director, Rehabilitation Services

Program Director, Cancer Support Services

Ephraim McDowell Health

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.

Treating with multiple therapists

We have a unique situation in our clinic I'd like to get the groups

thoughts

on. We have a patient that has dealt with lower extremity lymphedema

for a

number of years and in recent history has been able to manage this at

home.

We have been seeing him for the last month after a recent functional

decline

for gait training, balance training, and strengthening to help him

regain

his function. He was ill two weeks ago(flu) and was immobile for a

couple

of days, which exacerbated his lymphedema. We have a therapist in our

community that he has seen previously that he wishes to see for his

lymphedema, but wants us to continue working with him on his gait and

balance.

We have a staff member that could provide the lymphedema treatment, but

he

wants to return to his previous therapist for this. I've talked to him

about her doing his gait and balance training as well, but he refuses to

do

this with her because of a previous poor experience. In trying to

respect

his wishes, I was thinking about 'tag-teaming' the treatment with this

other

therapist by having her perform(and bill) for the manual aspect of his

lymphedema treatment and scheduling his treatment with us immediately

afterwards to address with gait and balance deficits.

My question is, if we use distinct ICD codes, have distinctly different

goals, and don't overlap treatment, can we both see and bill the patient

in

this type of 'co-treatment' on the same date of service. The patient

has

Medicare and my clinic is a private practice while the other therapist

is

hospital based.

I realize the simple thing would be for one clinic to do the complete

treatment, but so far the patient has resisted this.

Thanks for your input,

Gabe Freyaldenhoven, PT

River Valley Therapy and Sports Medicine

[Guest guest]

The issue is payment if the patient sees the 2 therapists on the same date of

service. Most likely, one claim will get reimbursed (first in) and the second

(last in) will not be reimbursed. No sense in clearing it with the Medicare

contractor since the claims are submitted electronically and no one is

physically looking at the claims.

Rick Gawenda, PT

President

Gawenda Seminars & Consulting, Inc.

Medicare Therapy Cap & Manual Medical Review Process Webinar

https://www.showmyevent.com/events/viewEventDetails.aspx?EventID=1992

Subject: RE: Treating with multiple therapists

To: PTManager

Date: Monday, August 27, 2012, 10:45 AM

 

I don't see an issue, each therapist has respective " expertise " Not

any different than the patients who seek specialists for any other care.

My concern would be payment, especially if the visits occur on the same

day . Perhaps clear it with his intermediary first?

Ron Barbato PT

Administrative Director, Rehabilitation Services

Program Director, Cancer Support Services

Ephraim McDowell Health

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.

Treating with multiple therapists

We have a unique situation in our clinic I'd like to get the groups

thoughts

on. We have a patient that has dealt with lower extremity lymphedema

for a

number of years and in recent history has been able to manage this at

home.

We have been seeing him for the last month after a recent functional

decline

for gait training, balance training, and strengthening to help him

regain

his function. He was ill two weeks ago(flu) and was immobile for a

couple

of days, which exacerbated his lymphedema. We have a therapist in our

community that he has seen previously that he wishes to see for his

lymphedema, but wants us to continue working with him on his gait and

balance.

We have a staff member that could provide the lymphedema treatment, but

he

wants to return to his previous therapist for this. I've talked to him

about her doing his gait and balance training as well, but he refuses to

do

this with her because of a previous poor experience. In trying to

respect

his wishes, I was thinking about 'tag-teaming' the treatment with this

other

therapist by having her perform(and bill) for the manual aspect of his

lymphedema treatment and scheduling his treatment with us immediately

afterwards to address with gait and balance deficits.

My question is, if we use distinct ICD codes, have distinctly different

goals, and don't overlap treatment, can we both see and bill the patient

in

this type of 'co-treatment' on the same date of service. The patient

has

Medicare and my clinic is a private practice while the other therapist

is

hospital based.

I realize the simple thing would be for one clinic to do the complete

treatment, but so far the patient has resisted this.

Thanks for your input,

Gabe Freyaldenhoven, PT

River Valley Therapy and Sports Medicine

[Guest guest]

I would recommend you have the patient sign an ABN if you will be seeing them on

the same day as they see the other therapist. This protects you if your services

are denied due to duplicate services on the same date of service.

Rick Gawenda, PT

President

Gawenda Seminars & Consulting, Inc.

Medicare Therapy Cap & Manual Medical Review Process Webinar

https://www.showmyevent.com/events/viewEventDetails.aspx?EventID=1992

Subject: Treating with multiple therapists

To: PTManager

Date: Sunday, August 26, 2012, 10:46 PM

 

We have a unique situation in our clinic I'd like to get the groups

thoughts

on. We have a patient that has dealt with lower extremity lymphedema for a

number of years and in recent history has been able to manage this at home.

We have been seeing him for the last month after a recent functional decline

for gait training, balance training, and strengthening to help him regain

his function. He was ill two weeks ago(flu) and was immobile for a couple

of days, which exacerbated his lymphedema. We have a therapist in our

community that he has seen previously that he wishes to see for his

lymphedema, but wants us to continue working with him on his gait and

balance.

We have a staff member that could provide the lymphedema treatment, but he

wants to return to his previous therapist for this. I've talked to him

about her doing his gait and balance training as well, but he refuses to do

this with her because of a previous poor experience. In trying to respect

his wishes, I was thinking about 'tag-teaming' the treatment with this other

therapist by having her perform(and bill) for the manual aspect of his

lymphedema treatment and scheduling his treatment with us immediately

afterwards to address with gait and balance deficits.

My question is, if we use distinct ICD codes, have distinctly different

goals, and don't overlap treatment, can we both see and bill the patient in

this type of 'co-treatment' on the same date of service. The patient has

Medicare and my clinic is a private practice while the other therapist is

hospital based.

I realize the simple thing would be for one clinic to do the complete

treatment, but so far the patient has resisted this.

Thanks for your input,

Gabe Freyaldenhoven, PT

River Valley Therapy and Sports Medicine

[Guest guest]

I would recommend you have the patient sign an ABN if you will be seeing them on

the same day as they see the other therapist. This protects you if your services

are denied due to duplicate services on the same date of service.

Rick Gawenda, PT

President

Gawenda Seminars & Consulting, Inc.

Medicare Therapy Cap & Manual Medical Review Process Webinar

https://www.showmyevent.com/events/viewEventDetails.aspx?EventID=1992

Subject: Treating with multiple therapists

To: PTManager

Date: Sunday, August 26, 2012, 10:46 PM

 

We have a unique situation in our clinic I'd like to get the groups

thoughts

on. We have a patient that has dealt with lower extremity lymphedema for a

number of years and in recent history has been able to manage this at home.

We have been seeing him for the last month after a recent functional decline

for gait training, balance training, and strengthening to help him regain

his function. He was ill two weeks ago(flu) and was immobile for a couple

of days, which exacerbated his lymphedema. We have a therapist in our

community that he has seen previously that he wishes to see for his

lymphedema, but wants us to continue working with him on his gait and

balance.

We have a staff member that could provide the lymphedema treatment, but he

wants to return to his previous therapist for this. I've talked to him

about her doing his gait and balance training as well, but he refuses to do

this with her because of a previous poor experience. In trying to respect

his wishes, I was thinking about 'tag-teaming' the treatment with this other

therapist by having her perform(and bill) for the manual aspect of his

lymphedema treatment and scheduling his treatment with us immediately

afterwards to address with gait and balance deficits.

My question is, if we use distinct ICD codes, have distinctly different

goals, and don't overlap treatment, can we both see and bill the patient in

this type of 'co-treatment' on the same date of service. The patient has

Medicare and my clinic is a private practice while the other therapist is

hospital based.

I realize the simple thing would be for one clinic to do the complete

treatment, but so far the patient has resisted this.

Thanks for your input,

Gabe Freyaldenhoven, PT

River Valley Therapy and Sports Medicine

[Guest guest]

I would recommend you have the patient sign an ABN if you will be seeing them on

the same day as they see the other therapist. This protects you if your services

are denied due to duplicate services on the same date of service.

Rick Gawenda, PT

President

Gawenda Seminars & Consulting, Inc.

Medicare Therapy Cap & Manual Medical Review Process Webinar

https://www.showmyevent.com/events/viewEventDetails.aspx?EventID=1992

Subject: Treating with multiple therapists

To: PTManager

Date: Sunday, August 26, 2012, 10:46 PM

 

We have a unique situation in our clinic I'd like to get the groups

thoughts

on. We have a patient that has dealt with lower extremity lymphedema for a

number of years and in recent history has been able to manage this at home.

We have been seeing him for the last month after a recent functional decline

for gait training, balance training, and strengthening to help him regain

his function. He was ill two weeks ago(flu) and was immobile for a couple

of days, which exacerbated his lymphedema. We have a therapist in our

community that he has seen previously that he wishes to see for his

lymphedema, but wants us to continue working with him on his gait and

balance.

We have a staff member that could provide the lymphedema treatment, but he

wants to return to his previous therapist for this. I've talked to him

about her doing his gait and balance training as well, but he refuses to do

this with her because of a previous poor experience. In trying to respect

his wishes, I was thinking about 'tag-teaming' the treatment with this other

therapist by having her perform(and bill) for the manual aspect of his

lymphedema treatment and scheduling his treatment with us immediately

afterwards to address with gait and balance deficits.

My question is, if we use distinct ICD codes, have distinctly different

goals, and don't overlap treatment, can we both see and bill the patient in

this type of 'co-treatment' on the same date of service. The patient has

Medicare and my clinic is a private practice while the other therapist is

hospital based.

I realize the simple thing would be for one clinic to do the complete

treatment, but so far the patient has resisted this.

Thanks for your input,

Gabe Freyaldenhoven, PT

River Valley Therapy and Sports Medicine

[Guest guest]

Hi everyone,

Medicare does allow for this as long as it is documented that you cannot

provide the service at your facility or the other therapist cannot provide

all the services either. Service most likely should be billed with a -59

modifier as well to alert that they were separate and distinct. Is the risk

of denial high? Probably but if you can deal with an appeal and can prove

my first statement about not being able to provide all the services at one

or the other clinic, then you probably will get paid down the line on

appeal.

The solutions that have been taken that I am aware of usually involve the

patient going to the other clinic for all services despite their past

problems OR they go get treatment at one clinic for one problem and delay

the therapy for the second. In your case, you would probably be the second

stop and would document a break in care and restart therapy with a

reevaluation and a new certification after treatment for the lymphedema is

done. Not the best case but seems manageable. You would also need good

communication with the physician as to any plan you decide.

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.

Treating with multiple therapists

We have a unique situation in our clinic I'd like to get the groups

thoughts

on. We have a patient that has dealt with lower extremity lymphedema

for a

number of years and in recent history has been able to manage this at

home.

We have been seeing him for the last month after a recent functional

decline

for gait training, balance training, and strengthening to help him

regain

his function. He was ill two weeks ago(flu) and was immobile for a

couple

of days, which exacerbated his lymphedema. We have a therapist in our

community that he has seen previously that he wishes to see for his

lymphedema, but wants us to continue working with him on his gait and

balance.

We have a staff member that could provide the lymphedema treatment, but

he

wants to return to his previous therapist for this. I've talked to him

about her doing his gait and balance training as well, but he refuses to

do

this with her because of a previous poor experience. In trying to

respect

his wishes, I was thinking about 'tag-teaming' the treatment with this

other

therapist by having her perform(and bill) for the manual aspect of his

lymphedema treatment and scheduling his treatment with us immediately

afterwards to address with gait and balance deficits.

My question is, if we use distinct ICD codes, have distinctly different

goals, and don't overlap treatment, can we both see and bill the patient

in

this type of 'co-treatment' on the same date of service. The patient

has

Medicare and my clinic is a private practice while the other therapist

is

hospital based.

I realize the simple thing would be for one clinic to do the complete

treatment, but so far the patient has resisted this.

Thanks for your input,

Gabe Freyaldenhoven, PT

River Valley Therapy and Sports Medicine

[Guest guest]

Hi everyone,

I have to take back the statement about using the -59 modifier. It was

based on a case in my files a number of years ago and when I finally found

the info in my files, I was mistaken about them getting this kind of

situation paid with using a -59 modifier-sorry about that.

I did double check on the other solutions and they are correct.

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.

From: PTManager [mailto:PTManager ] On Behalf

Of M. Howell PT, MPT

Sent: Monday, August 27, 2012 6:20 PM

To: PTManager

Subject: RE: Treating with multiple therapists

Hi everyone,

Medicare does allow for this as long as it is documented that you cannot

provide the service at your facility or the other therapist cannot provide

all the services either. Service most likely should be billed with a -59

modifier as well to alert that they were separate and distinct. Is the risk

of denial high? Probably but if you can deal with an appeal and can prove

my first statement about not being able to provide all the services at one

or the other clinic, then you probably will get paid down the line on

appeal.

The solutions that have been taken that I am aware of usually involve the

patient going to the other clinic for all services despite their past

problems OR they go get treatment at one clinic for one problem and delay

the therapy for the second. In your case, you would probably be the second

stop and would document a break in care and restart therapy with a

reevaluation and a new certification after treatment for the lymphedema is

done. Not the best case but seems manageable. You would also need good

communication with the physician as to any plan you decide.

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

IPTA Payment Specialist

Meridian, Idaho

<mailto:thowell@... <mailto:thowell%40fiberpipe.net> >

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.

Treating with multiple therapists

We have a unique situation in our clinic I'd like to get the groups

thoughts

on. We have a patient that has dealt with lower extremity lymphedema

for a

number of years and in recent history has been able to manage this at

home.

We have been seeing him for the last month after a recent functional

decline

for gait training, balance training, and strengthening to help him

regain

his function. He was ill two weeks ago(flu) and was immobile for a

couple

of days, which exacerbated his lymphedema. We have a therapist in our

community that he has seen previously that he wishes to see for his

lymphedema, but wants us to continue working with him on his gait and

balance.

We have a staff member that could provide the lymphedema treatment, but

he

wants to return to his previous therapist for this. I've talked to him

about her doing his gait and balance training as well, but he refuses to

do

this with her because of a previous poor experience. In trying to

respect

his wishes, I was thinking about 'tag-teaming' the treatment with this

other

therapist by having her perform(and bill) for the manual aspect of his

lymphedema treatment and scheduling his treatment with us immediately

afterwards to address with gait and balance deficits.

My question is, if we use distinct ICD codes, have distinctly different

goals, and don't overlap treatment, can we both see and bill the patient

in

this type of 'co-treatment' on the same date of service. The patient

has

Medicare and my clinic is a private practice while the other therapist

is

hospital based.

I realize the simple thing would be for one clinic to do the complete

treatment, but so far the patient has resisted this.

Thanks for your input,

Gabe Freyaldenhoven, PT

River Valley Therapy and Sports Medicine

[Guest guest]

Rick is definitely correct. One thing to keep in mind is never think of

billable service, and reimbursable service synonymously. You both certainly can

bill for the services, as they are (assumed) skilled and necessary. But both the

same day are not reimbursable. The primary reason being, this would potentially

allow the combined PT services between the two providers to exceed Medicare or a

private insurances reimbursement guidelines for hours/units billed per day.

You'd have the potential to bill two hours, or 8 units in the same day between

the two. To the third party payor, it would be no different than scheduling a

patient two different PT visits in the same day, at the same facility.

 

Bisesi MPT, COMT

Winter Haven, Fl

________________________________

To: PTManager

Sent: Monday, August 27, 2012 4:04 PM

Subject: RE: Treating with multiple therapists

 

The issue is payment if the patient sees the 2 therapists on the same date of

service. Most likely, one claim will get reimbursed (first in) and the second

(last in) will not be reimbursed. No sense in clearing it with the Medicare

contractor since the claims are submitted electronically and no one is

physically looking at the claims.

Rick Gawenda, PT

President

Gawenda Seminars & Consulting, Inc.

Medicare Therapy Cap & Manual Medical Review Process Webinar

https://www.showmyevent.com/events/viewEventDetails.aspx?EventID=1992

From: Ron Barbato <mailto:rbarbato%40emrmc.org>

Subject: RE: Treating with multiple therapists

To: mailto:PTManager%40yahoogroups.com

Date: Monday, August 27, 2012, 10:45 AM

 

I don't see an issue, each therapist has respective " expertise " Not

any different than the patients who seek specialists for any other care.

My concern would be payment, especially if the visits occur on the same

day . Perhaps clear it with his intermediary first?

Ron Barbato PT

Administrative Director, Rehabilitation Services

Program Director, Cancer Support Services

Ephraim McDowell Health

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.

Treating with multiple therapists

We have a unique situation in our clinic I'd like to get the groups

thoughts

on. We have a patient that has dealt with lower extremity lymphedema

for a

number of years and in recent history has been able to manage this at

home.

We have been seeing him for the last month after a recent functional

decline

for gait training, balance training, and strengthening to help him

regain

his function. He was ill two weeks ago(flu) and was immobile for a

couple

of days, which exacerbated his lymphedema. We have a therapist in our

community that he has seen previously that he wishes to see for his

lymphedema, but wants us to continue working with him on his gait and

balance.

We have a staff member that could provide the lymphedema treatment, but

he

wants to return to his previous therapist for this. I've talked to him

about her doing his gait and balance training as well, but he refuses to

do

this with her because of a previous poor experience. In trying to

respect

his wishes, I was thinking about 'tag-teaming' the treatment with this

other

therapist by having her perform(and bill) for the manual aspect of his

lymphedema treatment and scheduling his treatment with us immediately

afterwards to address with gait and balance deficits.

My question is, if we use distinct ICD codes, have distinctly different

goals, and don't overlap treatment, can we both see and bill the patient

in

this type of 'co-treatment' on the same date of service. The patient

has

Medicare and my clinic is a private practice while the other therapist

is

hospital based.

I realize the simple thing would be for one clinic to do the complete

treatment, but so far the patient has resisted this.

Thanks for your input,

Gabe Freyaldenhoven, PT

River Valley Therapy and Sports Medicine