• Using the 59 Modifier in 2014 Image

    articleJun 19, 2014 | 4 min. read

    Using the 59 Modifier in 2014

    Greetings, WebPTers! First, let me say thank you for the opportunity to chat with you today about appropriate use of the 59 modifier in 2014.  Even though we’ve been using the 59 modifier for some time now, there is still plenty of confusion and misunderstanding about when and how to use it. In fact, when we created our compliance plan, we listed use of the 59 modifier as a risk to be assessed and monitored.

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  • HIPAA Rules for Marketing and Sales Image

    articleMay 20, 2014 | 5 min. read

    HIPAA Rules for Marketing and Sales

    Today’s blog post comes from compliance expert Tom Ambury of PT Compliance Group and WebPT writer Erica Cohen. Before you get too far into your plans to beef up your clinic’s sales and marketing efforts, remember that you’re a healthcare provider first, which means you’ve got some HIPAA hoops to jump through (ahem, rules to follow) that the small business owner down the street probably doesn’t have to worry about. Before we get into that, though, let’s …

  • How to Comply with Conflicting Billing and State Practice Requirements—and Other  Useful Information Image

    articleApr 22, 2014 | 4 min. read

    How to Comply with Conflicting Billing and State Practice Requirements—and Other Useful Information

    I’ve recently received quite a few questions about how therapists can best meet conflicting billing and state practice requirements. Today, I thought I’d provide some clarity on that and explain why documentation is important for cash-based practices when it comes to addressing liability. Billing Requirements All payers—Medicare and private health insurance companies—maintain requirements that you must meet to receive reimbursement for your services. Additionally, each state has its own supervision requirements (based on license type) as documented …

  • Compliance Expert Tom Ambury Talks ICD-10 Image

    articleApr 10, 2014 | 3 min. read

    Compliance Expert Tom Ambury Talks ICD-10

    Everyone has been gearing up in preparation of the October 1, 2014, ICD-10 implementation deadline. (Even CMS changed their claim form requirements: beginning on April 1, 2014, if you submit paper claims, you must use CMS1500 version 2/12 instead of version 8/05.) No one thought there would be another delay—that is, until Thursday, March 27, when the House of Representatives passed HR 4302, a bill that contained a provision to delay the implementation and extend the therapy …

  • articleOct 24, 2013 | 4 min. read

    ICD-10: Is Your Clinic Ready?

    Today's post comes from Tom Ambury, PT and compliance officer at  PT Compliance Group , and  WebPT  cofounder and COO Heidi Jannenga, PT, MPT, ATC/L. Note: Congress has passed legislation to delay ICD-10 implementation until October 1, 2015. Read the full story here . Today, the ICD-10 implementation date is less than a year away. I know a year away can seem like a long time, but this will most likely be the major compliance initiative of 2014, …

  • articleJun 27, 2013 | 6 min. read

    Functional Limitation Reporting and You: What You Need to Know

    Wow, can July 1 really be right around the corner? Seems like yesterday we were only finding out about the requirement to document and report functional limitation G-codes and severity/complexity modifiers, and I think it really was only yesterday that CMS figured out how they would work. Let me start by making sure you understand that functional limitation reporting (FLR) and PQRS are separate and distinct programs and that each program has its own set of codes …

  • articleMar 7, 2013 | 5 min. read

    Medicare 8-Minute Rule: So Simple Yet Diabolically Complicated

    Today's post comes from Tom Ambury, PT and compliance officer at  PT Compliance Group . Thanks, Tom! “Tom, how can you make a statement that the Medicare 8-minute rule is simple yet diabolically complicated?” I can make that statement because even though this rule has been in effect for years—and thus, people should have the hang of it—mistakes still happen. And when I talk to therapists about it, a lot of confusion still exists. The 8-minute rule …

  • articleJan 16, 2013 | 5 min. read

    What are Compliance Programs and Why Does My PT Practice Need One?

    The concept of a compliance program is new to many in private practice physical therapy.  However, it’s a necessary aspect of any practice. Here are some common questions (and answers!) regarding a compliance program: What is a compliance program? A compliance program is a set of checks and balances to ensure that a physical therapy practice is meeting its established standards. Another way to look at it is that compliance is a quality program to ensure a …

  • Functional Outcome Measures Image

    articleNov 28, 2012 | 5 min. read

    Functional Outcome Measures

    Today's post comes from Tom Ambury, PT and compliance officer at  PT Compliance Group , based off this month’s “Compliance Chat” blog post . By now, I hope most of you are using functional outcome measures. If you haven’t started yet, you might want to consider taking the next few weeks to get prepared and begin the process in January of 2013. Why? Let’s start with the fact that physical therapy documentation is coming under greater scrutiny …

  • articleNov 12, 2012 | 5 min. read

    Details and Discussion on the $3,700 Threshold Update

    Today's post comes from Tom Ambury, PT and compliance officer at  PT Compliance Group , based off this month’s “Compliance Chat” blog post . We are now well into the exception process associated with the $3,700 threshold. The clinics that I’ve been working with have done fairly well in that they have not received any outright denials of services. But let's look at the responses we have received: The responses from the Medicare Administrative Contractors (MACs) have …

  • articleAug 30, 2012 | 5 min. read

    How to Bill for PTAs Providing Physical Therapy Services

    Today's post comes from Tom Ambury, PT and compliance officer at  PT Compliance Group , and WebPT cofounder and COO Heidi Jannenga, PT, MPT, ATC/L. One of the most frequently asked questions in the PT billing space is: "Our state practice act allows licensed PTAs to treat without direct onsite supervision. I understand that PTAs can’t bill under their own National Provider Identifier (NPI) and license, so how do I bill for my PTA’s services?" The answer: Don’t confuse …

  • articleAug 20, 2012 | 4 min. read

    How to Tackle Probe Audits

    Today's post comes from Tom Ambury, PT and compliance officer at PT Compliance Group . Thanks, Tom! Greetings, WebPT Members! It is a pleasure to write for your blog, which aligns directly with our philosophy of helping our fellow therapists practice confidently, efficiently, and profitably. I also enjoyed meeting a number of you at Evolve 2012: Long Beach last month. On July 30, " Health and Human Services (HHS) Secretary Kathleen Sebelius and Attorney General Eric Holder …

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