Why Physicians Medical Practice Cannot Make More Money
Jan09

Why Physicians Medical Practice Cannot Make More Money

Here are the 7 Common Reasons that I know make sense why many physicians cannot make more money! 1. Reimbursements are NOT being Maximized due to Poor Medical Coding Knowledge, Skill and Analysis Let me show you some example: a. Bilateral Procedure billed anatomically at only “one side” b. Surgery Converted to Open Procedure (the OP report documents from “Lap” to “Open” was performed) – how will you bill and code for this encounter? You may not know this, you cannot bill for both lap and open (check your CCI Edits!) together. And the guideline says, you have to report “Open” on your claim upon submission. c. Unbundling/bundling services that are billable based on the “Edits” and medical necessity d. No knowledge on how to utilize and use Modifiers e. Too naive that payments processed at 100% of the charged amount (“allowed amount”) is NOT GOOD! – it would’ve allowed more! 2. Out of Network Physician Services Payments can be a Big Challenge! Non-contracted physicians can be very challenging. Especially when they send the payments directly to their member / the patient! Any one experienced this? That’s why it is very important  that you make your patient sign a re-assignment of benefits so you get paid directly by the insurance company! You don’t have to accept assignment. 3. Lack of Effective Collection Techniques and Staff Training a. Copay is always due at the time of service – do many physicians do collect copay upfront? b. How often are patient statements being sent out? c. … there’s a lot more to site! 4. Now, isn’t it Time to Negotiate Fees and Update the Fee Schedule? When was the last time or have you ever thought of renegotiating your contracted fees? Wouldn’t it be time to analyze and review your contracts? Maybe its time to renegotiate your fees. 5. Missing “Revenue-Making” Opportunity for Additional Services in the Practice One good example, they know they can make big profit-margin on medically coded LSO Back Braces. And yet, they hesitate to even look at it. The truth is, it is always based on Medical Necessity! and Real-Time-Accurate Documentation, Period. You have to know your guidelines, policies and limitations. They are all out there, well documented. For instance, as a Physician, you are exempted to the Accreditation Process and Surety Bond – as long as you ONLY provide the LSO braces to your own patients as part of your services. READ HERE http://justmypassion.com/Who-are-Exempted-from-DME-POS-from-Accreditation-and-Surety-Bond-Application.html 6. Low Productivity is also one of the Reasons! a. Physician Services b. Accounts Receivables Collection 7. Too Much Cost Running the Practice a. Staffing b. Technology c. Supplies d. Lease There you...

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Physical Therapy Billing | Understanding Medicare Guidelines
Jan08

Physical Therapy Billing | Understanding Medicare Guidelines

Physical Therapy Billing  can be a challenge. It can definitely affect your reimbursement if you are not too sure how to properly submit your claims. These services are only covered if medically necessary. Coverage based on the diagnosis and the patient’s condition should also be determined. The patient’s diagnosis may be different of that from the… Please LOGIN HERE to view this content. Or, REGISTER HERE Find this article useful? Please comment below and share what you just found from this website! Go ahead - please click "SHARE"EmailTweetShare on...

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2017 What is the Therapy Limit Cap for Physical Therapy, OT and SLP Services?
Jan02

2017 What is the Therapy Limit Cap for Physical Therapy, OT and SLP Services?

The therapy cap limits for 2017 are: $1,980 for physical therapy (PT) and speech-language pathology (SLP) services combined $1,980 for occupational therapy (OT) services Need help with your billing? I can help you! Contact me today! CLICK HERE!   Find this article useful? Please comment below and share what you just found from this website! Go ahead - please click "SHARE"EmailTweetShare on...

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2017 New Evaluation Codes for OT | New Occupational Therapy Evaluation Codes
Jan02

2017 New Evaluation Codes for OT | New Occupational Therapy Evaluation Codes

Per CPT, these are the components in selecting the appropriate level of Occupational Therapy service. The first 3 components are very important that you must make sure they are appropriately scored. Insurance payers are looking at these 3 components if the right level code has been selected. So let’s look at each of these components and see how we choose the appropriate code level. Occupational profile and client history (medical and therapy) Levels for this Component includes: Low Complexity (Brief) Moderate Complexity (Expanded) High Complexity (Extensive) Assessments of occupational performance Levels of Assessment of Occupational Performance: Low Complexity (Problem-Focused) Moderate Complexity (Detailed) High Complexity (Comprehensive) CPT® Definition of Performance Deficits Performance deficits refer to the inability to complete activities due to the lack of skills in one or more of the categories below (i.e., relating to physical, cognitive, or psychosocial skills): Physical Physical skills refer to impairments of* body structure or body function (e.g., balance, mobility, strength, endurance, fine or gross motor coordination, sensation, dexterity). * AOTA regards “impairments of” as a typographical error and will be seeking revision because skills are not impairments. Cognitive Cognitive skills refer to the ability to attend, perceive, think, understand, problem solve, mentally sequence, learn, and remember, resulting in the ability to organize occupational performance in a timely and safe manner. These skills are observed when a person (1) attends to and selects, interacts with, and uses task tools and materials; (2) carries out individual actions and steps; and (3) modifies performance when problems are encountered. Psychosocial Psychosocial skills refer to interpersonal interactions, habits, routines and behaviors, active use of coping strategies, and/or environmental adaptations to develop skills necessary to successfully and appropriately participate in everyday tasks and social situations. Clinical decision making CPT® Code CPT® Language Low Complexity (97165) Clinical decision making of low complexity, which includes an analysis of the occupational profile, analysis of data from problem-focused assessment(s), and consideration of a limited number of treatment options. Patient presents with no comorbidities that affect occupational performance. Modification of tasks or assistance (e.g., physical or verbal) with assessment(s) is not necessary to enable completion of evaluation component. Moderate Complexity (97166) Clinical decision making of moderate analytic complexity, which includes an analysis of the occupational profile, analysis of data from detailed assessment(s), and consideration of several treatment options. Patient may present with comorbidities that affect occupational performance. Minimal to moderate modification of tasks or assistance (e.g., physical or verbal) with assessment(s) is necessary to enable completion of evaluation component. High Complexity (97167) Clinical decision making of high analytic complexity, which includes an analysis of the occupational profile, analysis of data from comprehensive assessment(s), and...

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2017 New Physical Therapy Evaluation Codes – Final Rule
Oct14

2017 New Physical Therapy Evaluation Codes – Final Rule

Here comes 2017 and we have 3 New Physical Therapy Evaluation Codes. CMS has proposed a new physical therapy codes for 2017 as part of the Medicare Physician Fee Schedule (CMS-1654-P) proposed rule for 2017 . We have now the: 2017 New Physical Therapy Evaluation Codes Key Points: Each of these codes are not “time-based”; typical time is used as a guidance only Complexity (low-medium-high) Therapy Evaluation encounter MUST meet Medical Necessity and clearly documents FUNCTION Use these new therapy evaluation codes for Medicare and commercial payers; Workers’ Comp and MVA liability may still be using 97001/97002 CPT Code 97001 is DELETED and REPLACED by 3 new physical therapy evaluation Codes CPT Code 97002 is DELETED and REPLACED by one single re-evaluation code These New Physical Therapy Evaluation Codes has 4 Components of Complexity and Severity: Patient Medical and Functional HISTORY, which includes relevant comorbities and personal factors; Comorbities/pre existing conditions that affects function and ability to progress through a plan of care History of Functional limitation(s) and level; current functional level, abilities and limitations Identify and Document Personal Factors that may impact the plan of care for Physical Therapy treatment; eg. age, gender, social history, education background, lifestyle, coping styles, job/profession, present/past experience. Document the overall behavior patterns including experience with disability Existing personal factors that will not impact the plan of care should not be used when selecting the level of service Examination of body system(s) using standardized tests and measures; Body Structures: Anatomical or structural parts of the body, eg., the organs, limbs and their components, classified according to the body systems; Body Regions: Includes the Head, neck, back, lower extremities, upper extremities and trunk Body Systems: Musculoskeletal (range of motions, strength, weight/height, symmetry) Neuromuscular (coordinated physical/body movement which includes gait transfers, locomotion and transitions) and motor functions on control and learning Cardiovascular Pulmonary (RR, HR, BP and Edema) Integumentary (skin integrity, texture, presence of scar formation) Review of Systems should also include orientation of person, place and time; consciousness, the ability to express/show needs, anticipated emotional and or behahavioral responses Clinical Presentation of the patient Stable and uncomplicated, OR Evolving clinical presentation with changing clinical characteristics OR Evolving clinical presentation with unstable and unpredictable characteristics Clinical Decision Making (based including the utilization of standardized patient assessment tools and or using the Functional Outcome measurable assessment result The codes are based in large part on the amount of time and complexity involved in the evaluation. See below identifies the new physical therapy codes for 2017 and gives the long-form description of each code. 2017 New Physical Therapy Evaluation Codes  CPT Code 97161 Physical therapy evaluation: low complexity, requiring these components: A history...

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ICD 10 Code Joint Pain | Physician Billing and Coding
Oct13

ICD 10 Code Joint Pain | Physician Billing and Coding

ICD 10 Code Joint Pain   M25.5 Pain in joint ( ICD 10 Code Joint Pain ) M25.50 is a specific ICD-10-CM diagnosis code M25.50 Pain in unspecified joint M25.51 Pain in shoulder ( ICD 10 Code Joint Pain ) M25.511 is a specific ICD-10-CM diagnosis code M25.511 Pain in right shoulder M25.512 is a specific ICD-10-CM diagnosis code M25.512 Pain in left shoulder M25.519 is a specific ICD-10-CM diagnosis code M25.519 Pain in unspecified shoulder M25.52 Pain in elbow ( ICD 10 Code Joint Pain ) M25.521 is a specific ICD-10-CM diagnosis code M25.521 Pain in right elbow M25.522 is a specific ICD-10-CM diagnosis code M25.522 Pain in left elbow M25.529 is a specific ICD-10-CM diagnosis code M25.529 Pain in unspecified elbow M25.53 Pain in wrist M25.531 is a specific ICD-10-CM diagnosis code M25.531 Pain in right wrist M25.532 is a specific ICD-10-CM diagnosis code M25.532 Pain in left wrist M25.539 is a specific ICD-10-CM diagnosis code M25.539 Pain in unspecified wrist M25.54 Pain in joints of hand M25.541 is a specific ICD-10-CM diagnosis code M25.541 Pain in joints of right hand M25.542 is a specific ICD-10-CM diagnosis code M25.542 Pain in joints of left hand M25.549 is a specific ICD-10-CM diagnosis code M25.549 Pain in joints of unspecified hand M25.55 Pain in hip ( ICD 10 Code Joint Pain ) M25.551 is a specific ICD-10-CM diagnosis code M25.551 Pain in right hip M25.552 is a specific ICD-10-CM diagnosis code M25.552 Pain in left hip M25.559 is a specific ICD-10-CM diagnosis code M25.559 Pain in unspecified hip M25.56 Pain in knee ( ICD 10 Code Joint Pain ) M25.561 is a specific ICD-10-CM diagnosis code M25.561 Pain in right knee M25.562 is a specific ICD-10-CM diagnosis code M25.562 Pain in left knee M25.569 is a specific ICD-10-CM diagnosis code M25.569 Pain in unspecified knee M25.57 Pain in ankle and joints of foot M25.571 is a specific ICD-10-CM diagnosis code M25.571 Pain in right ankle and joints of right foot M25.572 is a specific ICD-10-CM diagnosis code M25.572 Pain in left ankle and joints of left foot M25.579 is a specific ICD-10-CM diagnosis code M25.579 Pain in unspecified ankle and joints of unspecified foot M25.6 Stiffness of joint, not elsewhere classified ( ICD 10 Code Joint Pain ) M25.60 is a specific ICD-10-CM diagnosis code M25.60 Stiffness of unspecified joint, not elsewhere classified M25.61 Stiffness of shoulder, not elsewhere classified M25.611 is a specific ICD-10-CM diagnosis code M25.611 Stiffness of right shoulder, not elsewhere classified M25.612 is a specific ICD-10-CM diagnosis code M25.612 Stiffness of left shoulder, not elsewhere classified M25.619 is a specific ICD-10-CM diagnosis code M25.619 Stiffness...

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