Last week, WebPT’s trio of billing experts—Dr. Heidi Jannenga, PT, DPT, ATC/L, WebPT President and Co-founder; John Wallace, PT, MS, WebPT Chief Business Development Officer of Revenue Cycle Management; and Dianne Jewell, PT, DPT, PhD, WebPT Director of Clinical Practice, Outcomes, and Education—hosted a live open forum on physical therapy billing.
Modifiers help ensure you receive the appropriate amount of reimbursement for your physical therapy services—if you follow these rules.
During our denial management webinar, we discussed the difference between rejections and denials, explained how to handle both, and provided a five-step plan for stopping them in their tracks. The webinar concluded with an exhaustive Q&A, and we’ve amassed the most common questions here.
The rehab therapy industry is abuzz with PQRS talk right now. In case you missed it: PQRS as it exists today is dunzo. In 2017, it’ll be replaced with the Merit-Based Incentive Payment System, or MIPS. Unfortunately, though—and yes, it is unfortunate—PTs, OTs, and SLPs are not required to complete MIPS reporting until 2019. (And the jury is still out as to whether they’ll be able to voluntarily participate before then.)
Over the years, WebPT has a hosted a slew of billing webinars and published dozens of billing-related blog posts. And in that time, we’ve received our fair share of tricky questions. Now, in an effort to satisfy your curiosity, we’ve compiled all of our most common brain-busters into one epic FAQ. Don’t see your question? Ask it in the comments below. (And be sure to check out this separate PT billing FAQ we recently put together.)
Questions related to:
• Modifier 59
• Other Modifiers
• Advance Beneficiary Notice (ABN) of Noncoverage
• Contracts and Fee Schedules
• 8-Minute Rule
• Functional Limitation Reporting
• Cash-Pay Patients
How does WebPT help me bill better?
WebPT prompts users to apply modifier 59.
When WebPT detects that you have billed two codes that form a CCI edit pair, the system will alert you and ask whether you performed these services separately and distinctly of one another—and, therefore, should receive payment for both. If you attest that this is the case, WebPT will automatically apply modifier 59 to the appropriate code.
For WebPT Members
To activate this feature, please follow the steps below. Note that you’ll need to complete these steps for each insurance plan. We recommend applying this to commercial and government plans only (i.e. no workman’s compensation, legal/lien, and auto liability policies).
- Select “Display Insurance,” located on the left side of the WebPT Dashboard.
- Click “Edit” on the individual insurance for which you want to activate the feature.
- Once the insurance editing screen opens, check “Apply CCI edits”; then, select “Save.”
For Non-WebPT Members
If you’re not yet a WebPT Member, you can see this functionality and an array of other awesome features in a free, live online demonstration. Request one here.
WebPT tracks the therapy cap.
WebPT offers the Medicare Cap Report, which enables you to view Medicare beneficiaries’ progress toward the therapy cap and see whether therapists have affixed the KX modifier for those patients who have, in fact, exceeded the cap. In addition to tracking the therapy cap, WebPT alerts providers when a patient is:
- approaching the cap
- exceeding the cap (time to attach the KX modifier!)
- approaching the manual medical review threshold ($3,700)
- exceeding the manual medical review threshold
To learn more about the Medicare Cap Report and WebPT’s other compliance reporting and tracking capabilities, check out this blog post.
WebPT calculates the 8-minute rule.
As this blog post explains, “WebPT automatically double-checks your work for you and alerts you if something doesn’t add up correctly. All you have to do is record the time you spend on each modality as you go through your normal documentation process, along with the number of units you wish to bill. If those two totals don’t jibe, WebPT will not only let you know something’s off, but we’ll also tell you whether you overbilled or underbilled. That way, you can quickly identify and fix the problem—and thus, ensure accurate payment. Plus, you’ll have a detailed record of the services you provided on each date of service—something many local MAC auditors request to substantiate billing claims and processes.”
WebPT handles PQRS reporting.
WebPT is a certified PQRS registry. This means we collect PQRS claims data and submit it to Medicare on your behalf. We also have all the PQRS reporting requirements in our system, so depending on the Medicare beneficiary and visit, we’ll prompt you to complete the appropriate measure. Learn more about PQRS with WebPT.
What diagnosis code flows over from WebPT into my billing?
When you use WebPT, your treatment diagnosis is the one that is billed—not the medical diagnosis.
It’s a mad, mad, mad, mad Medicare world, and unfortunately, just about every regulation requires a modifier. If you apply the wrong modifier—or forget one entirely—then your clinic suffers decreased payments or flat-out denials. Even worse, if you amass enough modifier mistakes, you make your practice vulnerable to an audit.
The end of the year is upon us; time to ready our poppers, streamers, and sparkly hats for the ol’ ball drop. As we brace ourselves for another rousing rendition of Auld Lang Syne, it’s hard not to reflect on the year—clichéd as it may sound. Another cliché: End-of-year lists. But we love them nonetheless; that’s why I amassed the WebPT Blog’s top ten posts of 2014. Overarching themes?
Is Medicare denying your claims for improper functional limitation reporting? These tricky FLR scenarios might be to blame. Learn how to ensure you get paid.
As of July 1, 2013, the Centers for Medicare and Medicaid Services (CMS) requires that therapists complete functional limitation reporting (FLR)—through the use of G-codes and severity modifiers—on all eligible Medicare Part B patients at the initial evaluation, re-evaluation if applicable, every progress note (minimum of every ten visits), and discharge in order to receive reimbursement for their services. Today, several other private insurance companies also require FLR data as a condition of reimbursement. Good thing WebPT has you covered. Read on to learn how Members can use our totally free, built-in, easy-to-use functional limitation reporting feature.
Prior Level of Function
In the Subjective Tab, you’ll find a section labeled Prior Level of Function. There, you will select your patient’s prior level of function—the areas in which the patient was independently functioning prior to seeking treatment. This information provides supporting evidence and context for your patient’s history. (Note that this section is Medicare required. If you miss this step for a Medicare patient, an alert will prevent you from finalizing your note.)
Current Functional Limitation
Next, you’ll see the Current Functional Limitation section. There, you’ll select your patient’s current functional limitation(s) (check all that apply). This information will also provide supporting evidence and context for your patient. (Note that this section is also Medicare required. If you miss this step for a Medicare patient, an alert will prevent you from finalizing your note.)
Primary Functional Limitation
From there, we’ll prompt you to select your patient’s primary functional limitation category (self care; changing and maintaining body position; mobility: walking and moving around; carrying, moving, and handling objects; or other). Based on this information and the visit type, we’ll autocomplete your G-codes.
Objective Measurement Tools
To identify your patient’s current functional severity and track his or her progress towards the goal, you’ll use the results of an outcome measurement tool (OMT) and your clinical judgement. In this section of the Objective Tab, you’ll be able to select, perform, and score your OMT—and we’ll help you decide which tools to use. There will be a badge next to the outcome measurement tools we feel are most appropriate to use considering your patient’s primary functional limitation (e.g., “M” for mobility: walking and moving around). You can go with our suggestion or choose your own.
Under Status Modifier, you can select the appropriate severity modifier for your patient’s current status (how severe the patient’s limitation is at this moment in time) and projected long-term goal status (how severe you believe the patient’s limitation will be at the end of treatment). This is the first of two opportunities you’ll have to actually apply severity modifiers. If you choose to skip this step here, you must complete it in the Assessment Tab.
Beneath the Assessment/Diagnosis field, you will have a final opportunity to choose your severity modifiers. Here, you can also document the clinical rationale you used to make your selection. This text box will automatically populate based on the outcome measurement tools you selected. (If you already made your severity modifier selections in the Objective Tab but now wish to change them, you may do so using the dropdown menus in this section. Your new selections will replace those in the Objective Tab.)
Problem List and Goals
WebPT will automatically transfer your patient’s primary functional limitation and corresponding goals into the Problem List and Goals test boxes. We will also adjust your goal met percentages in accordance with your patient’s progress. However, you will still need to manually select a goal duration using the dropdown menus.
Your finalized daily note will automatically display your patient’s primary functional limitation, current status, projected goal status, rehab potential, and long-term goal.
On your next progress note (at minimum on your patient’s tenth visit), the system will prompt you to complete functional reporting again. Here, you’ll perform an OMT and—using the results and your clinical judgment—update your patient’s status and severity modifiers as well as verify his or her long-term goal. Just like on the initial evaluation, this information will automatically appear in the problem list and goals boxes.
It appears we have a theme going this week. Brooke devoted Monday and Tuesday to discussing WebPT’s business reports. Yesterday, I showed you the ins and outs of the Plan of Care Report. But monitoring your Medicare compliance doesn’t end there. Here are a few more helpful reports:
Medicare Payment Adjustment Report (MPAR)
The Medicare Payment Adjustment Report (MPAR) shows you how multiple procedure payment reductions (MPPR) are affecting your clinic’s profits and losses. Most practice management systems do not provide this data, so this report gives WebPT clinics a significant advantage as they can assess the impact of MPPR and adjust their processes accordingly.
To access the MPAR, click “MPA Report,” located under the Reports section on the left side of the WebPT application. Once inside the MPAR, you will see search fields for Time Period, Patient, and Therapist. You’ll create the report using the Patient field. Simply search for a Medicare patient with finalized notes. Patient names will start to appear as you type, but be sure to enter a minimum of three letters. To access a patient, select his or her name and click “Generate Report.”
To see additional screenshots and further instructions, check out the MPAR user guide.
According to the Centers for Medicare & Medicaid Services (CMS), the MPPR-applied discount for institutional and noninstitutional facilities will be 50% on the second and subsequent procedure each day. You can view fee amounts inside the Medicare Fee Schedule (located in your clinic’s dropdown menu in the top-right corner of your WebPT dashboard). Please note that in order for the Medicare Fee Schedule to function, you must select regional location and facility type within Clinic Settings, which you can also access from your clinic’s dropdown. We pull these fees directly from CMS. For more on MPPR calculations and formulas, check out this CMS page and this APTA page.
For more details on MPPR and the fee schedule, check out this user guide.
Medicare Cap Report
Another essential compliance report is the Medicare Cap Report, which allows you to view your Medicare patients’ progress toward the therapy cap. It also enables you to see whether your therapists have attached the KX modifier for those patients who’ve exceeded the cap. This report also has an alert system associated with it. The rules of the therapy cap can be overwhelming and tricky, to say the least. Luckily, our report and alerts help keep you on the right side of the regulations.
To access the Medicare Allowable Cap Report, click “Medicare Cap Report” located under Reports on the left side of the Dashboard.
As for the alerts, they appear when a patient is:
- approaching the cap
- exceeding the cap (time to attach the KX modifier!)
- approaching the Manual Medical Review threshold ($3,700)
- exceeding the Manual Medical Review threshold (in which case you must apply to CMS for a manual medical review)
Another WebPT perk? For those who have the Front Office Package, you can view a patient’s progress toward the therapy cap within the Scheduler.
Click here to access the therapy cap report and alerts user guide.
Speaking of tricky Medicare regulations, functional limitation reporting (FLR) was probably the most intense Medicare regulatory change in all of 2013. Not only did WebPT create an integrated reporting tool to ensure you’re FLR compliant, but we also developed a report that provides you with real-time business intelligence regarding FLR. The report shows you:
- patients seen
- total visits
- G-codes reported, as well as those used most frequently