WebPT Blog - claims
May 21, 2013| by Chuck Felder, PT, DPT, SCS, MBA
Today’s blog post comes from Chuck Felder, PT, DPT, SCS, MBA. For follow-up questions, please email Chuck at CFelder@HCSconsulting.com.
In 2012, CMS began a process of reducing payment for therapy services based on multiple procedures performed during the same visit. This is termed the Multiple Procedure Payment Reduction (MPPR). Despite APTA’s and others best efforts to get this removed, CMS began a 20% reduction policy on the second and subsequent procedure each day. This is in effect for all therapy services provided on a single day. So, if the patient received OT on the same day as PT, CMS would pay the highest value procedure at 100% and reduce all subsequent procedures that day by 20% of the practice expense component. Overall, the average visit with around 3.7 units would have its payment reduced about 6%–7%. For the first quarter of 2013, CMS continued the 20% reduction policy. However, they’ve since switched to a 50% reduction.
Mar 29, 2013| by Stacey Abelman
Today’s blog comes from WebPT’s Billing Onboarding & Operations Manager Stacey Abelman. Thanks Stacey!
I wish I could tell you that today’s blog was going to be about how to make rehab therapy billing a breeze. But it’s not. There’s no magic answer, no simple solution, and certainly no easy-as-pie fix. Not to fear, though. There are things you can do—steps you can take—to make sure your billing processes are at their very best so you’ll increase your revenue and decrease your headaches. Here are ten:
1. Make a Plan
What’s your clinic’s one-year plan? How about your five-year? Oftentimes, the answer is purchase new equipment, open a second location, or bring on an additional provider. Regardless of your particular goal, though, the first step is always the same: start making a plan of how you’re going to achieve it. And I’m guessing that increasing cash revenue will fall somewhere on this plan. If so, it’s time to start looking at your billing department. Maybe, to meet your practice goal, you need to set some billing specific goals—like decreasing accounts receivable (A/R) greater than 90 days down to less than 10% or sending all claims to carriers in less than two business days. Regardless of your goals—billing-specific and overall clinic—put it on paper, communicate it to your team, and break it into manageable steps.
Aug 9, 2012| by Charlotte Bohnett
This blog post comes from WebPT copywriters Charlotte Bohnett and Erica Cohen.
Medicare compliance is one very tough nut to crack as is navigating the murky waters of medical insurance billing. We’ve filled this month’s blogs with all sorts of valuable and applicable information on everything from HIPAA to autonomy. But what Medicare obstacles do you grapple with daily? Today, let’s talk the five most frequently asked questions regarding Medicare.
1.) What is the Therapy Cap?
According to the APTA’s FAQs on the Therapy Cap and KX Modifier, under the Balanced Budget Act (BBA) of 1997, Congress placed an annual cap on rehabilitation services through Medicare. That means that Medicare will only reimburse you as the rehabilitation therapist up to a certain dollar amount per patient regardless of services provided.
In 2012, that annual per beneficiary therapy cap is $1,880 for physical therapy and speech language pathology services combined, and there is a separate $1,880 amount allotted for occupational therapy services.
Note: While the Medicare Advantage plan may apply a $1,880 therapy cap with an exceptions process, many Medicare Advantage plans have chosen not to apply a therapy cap in the past. Please check with your Medicare Advantage plan regarding its payment policies.
Read WebPT cofounder, COO, and PT Heidi Jannenga’s take on the therapy cap in her blog post, “Save the Day the CMS Way.”APTA, billing, claims, CMS, compliance, feee schedule, insurance, kx modifier, medical, medicare, reimbursement, therapy cap
Feb 9, 2011| by Heidi Jannenga PT
The Physician Quality Reporting Initiative (PQRI) is a program designed by the Center for Medicare and Medicaid Services (CMS) to improve the quality of reporting in the healthcare industry. The program is now considered to be permanent and therefore the program name has been amended to the Physician Quality Reporting System (PQRS). PQRS reporting is based on individual measures which are associated to a specific patient group by diagnosis, ailment, age, or clinical action taken by the reporting therapist. All Medicare Part B FFS (fee for service) patients are eligible, but must meet inclusion criteria for each measure.
There are 2 methods of reporting your clinical data to CMS: Claims-based and Registry. Choosing your reporting method is very important in reaching your 1% incentive goal. What is the difference between the 2 methods? What are the Pros and Cons of each? Let’s explore: