It appears 2020 has a few more tricks up its sleeve for physical therapists and occupational therapists. According to an announcement from the Centers for Medicare and Medicaid Services (CMS), the agency has decided to reinstate changes to National Correct Coding Initiative (NCCI) edit pairs that are frequently used by rehab therapists.
PTs commonly perform services that are similar to one another. To make the billing process a bit easier, they can form “edit pairs” for certain Medicare services.
When someone mentions the words “physical therapy billing,” terms like “easy” or “simple” probably don’t leap to mind. After all, every payer has its own way of doing things, and the rules are rarely straightforward—especially when you start throwing in other terms like “8-minute rule” or “mixed remainders.”
As part of the COVID-19 response, Medicare and many commercial payers have opened new opportunities for rehab therapists…
Following several CMS announcements that providers were overusing modifiers 25 and 59 as a means to bypass edit pairs (without supplying proper documentation to support those bypasses), multiple commercial payers—including Anthem, Aetna, and Humana—adopted front-end claim edit policies for claims containing these modifiers.
In response to the COVID-19 pandemic, regulations are changing and loosening to help facilitate the delivery of remote rehab therapy services. That way, patients can continue to receive the care they need while simultaneously limiting the spread of the virus.
If you suspect fraud, abuse, or even waste occurring in your PT, OT, or SLP practice, here are some steps for addressing it.
Over the years, we’ve written quite a few blog posts about Medicare—covering everything from Medicare and direct access to Medicare supervision requirements—and I don’t foresee that stopping any time soon. After all, there are so many intricacies and nuances to navigating Medicare that we have fodder to write until, well, either the end of time or the end of Medicare—whichever comes first.
Which billing solution is right for your practice: billing software, RCM service, or a hybrid of the two? Rehab therapists have several options for handling their billing processes—but knowing which one is best for their practice isn’t always easy. That’s why we created this handy flowchart, which can help point PTs, OTs, and SLPs to the billing solution that’s right for them and their practices. Enter your email address below to receive a free copy of our
Whether you’re just starting out as a Medicare provider—or you’re making the switch from inpatient to outpatient—there’s a lot to keep straight when it comes to the complicated rules, regulations, and policies that govern Original Medicare (which consists of both Part A and Part B).
Is your relationship with billing complicated at best? I get it. Figuring out how to bill insurance companies for private practice physical therapy can seem daunting, especially in light of ever-changing regulations.