• Can PTs Bill for Assessment and Management Time? Image

    articleDec 17, 2018 | 5 min. read

    Can PTs Bill for Assessment and Management Time?

    There’s a lot of confusion around whether PTs can bill for assessment and management time. The short answer is “yes,” PTs can—and should—account for assessment and management time in their billing and documentation. Yet, as it stands, many PTs don’t. And that’s a shame—because in failing to do so, they are not only leaving money on the table, but also seriously undervaluing their services . In other words, if you’re not billing for assessment and management time, …

  • FAQ: Unwrapping MIPS and the Final Rule: How to Prepare for 2019 Image

    articleDec 14, 2018 | 37 min. read

    FAQ: Unwrapping MIPS and the Final Rule: How to Prepare for 2019

    Earlier this week, Heidi Jannenga, PT, DPT, ATC, WebPT President and Co-Founder, and Dianne Jewell, PT, DPT, PhD, FAPTA, WebPT Director of Clinical Practice, Outcomes, and Education, hosted an hour-long webinar that unwrapped the many layers of MIPS and the 2019 physician fee schedule. Unsurprisingly, tearing through the layers of CMS’s latest gift revealed a crush of questions—many of which our experts didn’t have time to fully address. So, we compiled the most frequently asked ones for …

  • 8 Simple Rules for Creating a Medicare POC Image

    articleDec 3, 2018 | 5 min. read

    8 Simple Rules for Creating a Medicare POC

    “Simple” and “Medicare” are rarely used in the same sentence, but that doesn’t have to be the case—especially when it comes to developing physical therapy, occupational therapy, and speech-language pathology plans of care (POCs) and adhering to certification requirements. While these treatment outlines might seem daunting at first, there are totally easy-to-follow guidelines to ensure yours are always comprehensive and compliant. To that end, here are eight simple rules for creating a Medicare POC—so you can provide …

  • 3 Reasons You Should Absolutely Bill Medicare for Maintenance Therapy Image

    articleNov 27, 2018 | 4 min. read

    3 Reasons You Should Absolutely Bill Medicare for Maintenance Therapy

    My car is my baby. I get the oil changed and tires rotated regularly. And every few weeks, I take her through the wash and get her looking good as new. I won't lie: I learned the importance of ongoing maintenance through much trial and error. Still, the cost of caring for my ride adds up, and it'd be nice if I didn't always have to pay out of pocket for regular maintenance. And while caring for …

  • 5 Medicare Compliance Issues for Cash-Based PTs Image

    articleNov 20, 2018 | 6 min. read

    5 Medicare Compliance Issues for Cash-Based PTs

    Cash-based physical therapy practices are all the rage these days, and with good reason. They give PTs the opportunity to focus on providing quality care—without the pressure of altering treatments or billing practices to keep insurance payers happy. At the same time, PTs can get into hot water if they blindly accept cash from anyone willing to pay. And things get especially hairy when it comes to Medicare patients. So, can a Medicare patient pay out of …

  • Double Duty: How to Bill for PT and OT on the Same Day Image

    articleNov 12, 2018 | 6 min. read

    Double Duty: How to Bill for PT and OT on the Same Day

    In many cases, physical therapy and occupational therapy go together like peanut butter and jelly. PTs and OTs often share similar goals and interventions, treat the same types of patients in the same settings, and get confused by the billing rules that apply to our respective specialties. This confusion leads to quite a few questions, including this head-scratcher: how does one bill for OT and PT provided to a single patient on the same day? While the …

  • Spot the Difference: Rules for Medicare vs. Medicare Advantage Image

    articleNov 9, 2018 | 5 min. read

    Spot the Difference: Rules for Medicare vs. Medicare Advantage

    Medicare and Medicare Advantage (MA) plans have similar structures, because MA plans are required to (at minimum): offer the same benefits that traditional Medicare provides to its beneficiaries, and adhere to all CMS National and Local Coverage Determinations. However, there are some significant differences between the two . And that makes sense given that traditional Medicare is government-operated, while Medicare Advantage plans are operated by Medicare-approved private companies. Thus, many of the core Medicare requirements don't automatically …

  • Should PTs, OTs, and SLPs use the New X Modifiers? Image

    articleNov 7, 2018 | 4 min. read

    Should PTs, OTs, and SLPs use the New X Modifiers?

    When it comes to Medicare, a lot can change in four years—whether it be the rise and fall of functional limitation reporting or answers to questions like, “Do outpatient rehab therapists have to report MIPS?” (You can get that answer here , by the way.) So, when CMS introduced the X modifiers back in 2015 and told PTs, OTs, and SLPs they wouldn't have to use them, anyone familiar with Medicare rules knew that advice was subject …

  • CMS’s Final Bow: The 2019 Final Rule Image

    articleNov 5, 2018 | 8 min. read

    CMS’s Final Bow: The 2019 Final Rule

    Last week, the Centers for Medicare and Medicaid Services (CMS) published its 2019 final rule . Clocking in at just over 2,300 pages, the final rule isn't exactly a light read—especially because the legal lingo can be harder to interpret than Shakespearean verse. Luckily, we have the script—with all its twists and turns—decoded and ready for you to review. Here's the synopsis of all the physical therapy, occupational therapy, and speech-language pathology Medicare changes for 2019: Out, …

  • 9716-What? When to Bill for PT Evals and Re-Evals Image

    articleNov 2, 2018 | 5 min. read

    9716-What? When to Bill for PT Evals and Re-Evals

    Over the years, we've received a lot of questions about when to bill for an evaluation versus a re-evaluation , and when you look at the description for CPT code 97164 (PT Re-evaluation), it's easy to see why. According to the American Medical Association , 97164 denotes a re-evaluation of an established plan of care, which requires these components: “an examination including a review of history and use of standardized tests and measures;” “a revised plan of …

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