Insurance Payment Paid and Allowed 100% of Charged Amount – don’t celebrate! Let me tell you why!
Mar12

Insurance Payment Paid and Allowed 100% of Charged Amount – don’t celebrate! Let me tell you why!

I asked some of my readers about how they will feel if their claims has an allowed amount that is at 100% of the charged amount, wow! So, meaning, when you bill for $2000.00 and the insurance made their determination at 100% of your charges… you bill $2,000, they allowed $2,000 – would you be happy?… 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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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 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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2015 Useful New Modifiers for Physical Therapy Billing and Coding
Dec02

2015 Useful New Modifiers for Physical Therapy Billing and Coding

Beginning January 1, 2015 – CMS had developed 4 new Modifiers that can be useful for therapy service provider. As a consultant helping many of my therapy service provider-clients, I think this could would be more appropriate to use than the modifier 59 These new modifiers are subsets of Modifier 59 For example, using modifier XS when you are treating a patient with two different anatomic site (knee, and back) … this is an appropriate modifier to use. 97110 –                (DX Pointer- Code V43.65, 717.9) 97110 – XS          (DX Pointer- Code 724.4) Say hello to your 2015 Useful New Modifiers for Physical Therapy Billing and Coding Modifier XE Separate encounter: A service that is distinct because it occurred during a separate encounter Modifier XP Separate practitioner: A service that is distinct because it was performed by a different Modifier XS Separate structure: A service that is distinct because it was performed on a separate organ/structure Modifier XU Unusual non-overlapping service: The use of a service that is distinct because it does not overlap usual components of the main service Reference: 2015 CMS Modifier 15 Changes Transmittal 1422 CR 8863 Although, CMS will continue to recognize Modifier -59 but you have to make sure you will only utilize modifier 59 when there is no other specific modifier that may describe your “distinct” procedure service. When using this modifier, Medical Documentation is vital and essential to support medical necessity. This must be well-documented on the patient’s medical record. Searched Keywords: pt new eval codes, occupational therapy cpt codes, physical therapy cpt codes 2017, cpt code 97140, cpt code 97530, cpt code 97001, cpt code 97112, cpt code 97535, cpt code 97014, revenue cycle management, how much is clinicient, how much is webpt, webpt versus clinicient, webpt review, webpt documentation, webpt reviews, why use webpt, webpt versus clinicient, cpt 97001, 2017 new, physical therapy codes, out of network physical therapist, out of network doctor, out of network provider, billing functions for physical therapy, looking for physical therapy billing service, physical therapy billing service in new jersey, billing percentage, how to bill physical therapy, modifier go, modifier kx, medicare physical therapy cap, 97110 cpt, cpt 97140, cpt code 97112, cpt code 97116, cpt 97001, physical therapy cpt codes, cpt code 97035, cpt code 97014, cpt code 97535, medicare pt audit, how to bill medicare for pt, how to bill medicare for physical therapy, how to start a pt practice. how to start a physical therapy practice, physical therapy credentialing, rcm Find this article useful? Please comment below and share what you just found from this website! Go...

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