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Billing for Services:

Billing for Services Administration and Management HSC

The First Step to Success:

The First Step to Success Gaining the needed information for the Client Check for a referral from a Physician Identify benefits to include number of visits and general coverall and limitation Identify any co-payments Complete and sign all appropriate documents and obtain release of information documents and HIPPA forms

Understand What You Are Billing For!:

Understand What You A re Billing For! K nowledge of Common Procedural Terminology (CPT) code structure Knowledge of International Classification of Disease (IDC) 9 and 10 code Knowledge of fee schedules

Ways to Submit Billing:

Ways to Submit Billing Paper Claims: Must be current version CMS Health Insurance Claim Form (HCFA 1500) Electronic Claims: Use the CMS, Medicaid, or private payer website to input and submit billing May need to use a outsourced agency to submit claims due to regulations

What information do you need to complete billing?:

What information do you need to complete billing? Client’s personal information Insurance information, Primary and Secondary Diagnosis Code (IDC-9/IDC-10) Referral Source Date of service CPT Codes for interventions carried out, along with service identification Time based codes Service based codes Therapist documented units or time length for service National Provider Identification Number (NPI) Location of services Provider information The BIG changes in Medicare Part B billing effective January 201 G-Codes Functional Reporting Codes THE EVEN BIGGER CHANGES FOR OCTOBER 2015 related to all billing is the use of IDC-10 Codes will be mandated for all service providers.

Other things to think about or know about :

Other things to think about or know about Explanation of benefits (EOBs) or Remittance Advises (RA) Denials and appeals Write-offs Coordination of benefits Primary insurance Secondary insurance Deductibles, copays, and out of pocket expenses Advanced Beneficiary Notice (ABN) Anticipate denial for reimbursement and give advanced notice to client Notification is written Allows you to bill the client for services that may be denied Notice of Exclusion from Medicare Benefits (NEMB) Inform client of reimbursement limitations Inform client of their responsibility to cover costs over the cap limit or services not covered, following a discussion with and education of client

CPT Codes Related to Therapy The 97000 Series:

CPT Codes Related to Therapy The 97000 Series Most important to therapists These codes are specific to physical medicine and rehabilitation Evaluation and re-evaluation Modalities Supervised Constant Attendance Therapeutic procedures Test and measurements Orthotics and prosthetic management

Non-Timed CPT Codes:

Non-Timed CPT Codes Evaluation OT- 97003 Re-evaluation OT- 97004 Evaluation PT- 97001 Re-evaluation PT- 97002 Mechanical Traction- 97012 Unattended E- stim - 97014 Vasopneumatic device- 97016 Paraffin Bath- 97018 Wound Care- 97597 Group Therapy- 97150 RULE: Can only be billed one time per day regardless of number of body parts involved. Do not require one to one contact between therapist and client, with the exception of evaluations and re-evaluations. Evaluations signal the start of an episode of care, while re-evaluations must be comprehensive and not used every visit.

Timed CPT Codes:

Timed CPT Codes Attended E- Stim - 97032 Ultrasound- 97035 Therapeutic Activity- 97530 Manual Therapy- 97140 Aquatic Therapy- 97113 Neuromuscular re-education- 97112 Assistive technology assessment- 97755 Massage- 97124 Therapeutic exercise-97110 Self-care management- 97535 W/C management- 97542 Prosthetic/ o rthotic checkout- 97762 Gait training- 97116 Cognitive skills development- 97770 Therapist can bill for multiple units of time spent in DIRECT contact The “8 minute rule” is in place To bill for each additional time based code, therapists MUST spend at least 8 minutes of each unit providing DIRECT service to the client The session MUST last at least 8 minutes and be documented. Time for entire session needs to be documented and time per intervention documented in notes for accurate billing and reimbursement

Timed Examples of Therapeutic CPT Codes:

Timed Examples of Therapeutic CPT Codes 97140: Manual Therapy (mobilization, manipulation, manual traction, manual lymphatic drainage) 97530: Therapeutic Activities “ dynamic activities to improve functional performance ” (transfer training, self care management 97542 : Wheelchair Management (assessment, fitting, training) Direct one-on-one contact with client, required.

Test and Measures Timed CPT Codes Requiring a Written Report:

Test and Measures Timed CPT Codes Requiring a Written Report 97750: Performance Testing FCE (Functional Capacity Evaluation ) 97755 : Assistive Technology Assessment Seating Mobility Environmental controls

Constant Attendance Interventions:

Constant Attendance Interventions These are timed procedures Require direct therapist one to one contact Involves one or more areas Attended E- stim - 97032 Iontophoresis - 97033 Ultrasound- 97035

PowerPoint Presentation:

Guidelines for Medicare's 8 Minute Rule 15 minute codes Treatment Units 1 unit 8 minutes to 22 minutes 2 units 23 minutes to 37 minutes 3 units 38 minutes to 52 minutes 4 units 53 minutes to 67 minutes 5 units 68 minutes to 82 minutes 6 units 83 minutes to 98 minutes The first procedure must be at least 8 minutes, with each one thereafter billed in 15-minute increments. A minimum of a 23-minute session is required in order to bill for two units. Only documented direct, face-to-face time with the patient is considered for timed codes. (This excludes rest time or toileting, time spent waiting on equipment ,etc.)

Tracking of Minutes:

Tracking of Minutes The number of units billed is determined by the total time for all timed-based services. Total number of units billed will always be limited by the total treatment time !!! Example One Massage x 13 minutes + t herapeutic exercise x 9 minutes + Gait training x 22 minutes. How many units can you bill for?

Example Two:

Example Two If 24 minutes of therapeutic exercise (97110) and 23 minutes of sensory integration (97533) were furnished, the total treatment time would be 47 minutes. Utilizing the “ 8 minute rule ” chart, 3 units can be billed for the 47 minute treatment: 1 unit of sensory integration, 2 units of therapeutic exercise (assigning more units to the service that took the most time)

Example Three:

Example Three 20 minutes of neuromuscular reeducation (97112) + 20 minutes therapeutic exercise (97110) 40 Total timed code minutes . The appropriate billing for 40 minutes is 3 units. Each service was done at least 15 minutes and should be billed for at least one unit, but the total allows 3 units. Since the time for each service is the same, choose either code for 2 units and bill the other code for 1 unit. (You are not allowed to bill 3 units for just one of the codes i.e 3 x 97112)

General Billing Comments:

General Billing Comments Bill all non-timed CPT procedures provided without respect to the time of each procedure, but remember you can only bill each non-timed one time per session Bill for appropriate time-based CPT procedures that are > 8 minutes. Any time-based procedure that was provided in less than 8 minutes can not appear on the bill. Total the minutes of all time-based procedures. Apply the appropriate number of units based on the total minutes of all time-based procedures.

Medicare’s Newest Addition The G-Codes are Now Here to Stay:

Medicare’s Newest Addition The G-Codes are Now Here to Stay G-codes are a means for CMS to collect data one the effectiveness of therapy services and outcomes data for a 5 year period related to the beneficiary/recipient of therapy services The intent is to support payment reform based on outcome data Implementation for the inclusion of G-codes began mandatory on January 1, 2014 Only claims having G-codes and modifiers will be processed for payment effective January 1, 2014 Therapists can find instructions and educational materials related to the use of G-codes and modifiers on the CMS website

What are G-Codes?:

What are G-Codes? “G-codes are a claims-based data collection requirement for outpatient therapy services by requiring the reporting of 42 new non-payable functional G-codes and 7 new modifiers on claims for physical therapy (PT), occupational therapy (OT), and speech and language pathology (SLP) services.” Centers for Medicare and Medicaid Services, CMS, 2013

When are G-Codes Used?:

When are G-Codes Used? G-codes and their respective modifier are reported on billing submissions at the outset of the therapy report or at the time of initial evaluation billing. G-codes and modifiers are reported on or before the 10 th treatment day and on or before each continued 10 th treatment day. At this time, both the initial G-code and modifier and a progress G-code and modifier are reported reflecting the level of function at the point of reporting. G-codes and modifiers are reported at the time of discharge and include the initial G-code and modifier and the respective G-code and modifier reflection function at the time of discharge.

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