On the WebPT Blog, we receive a whole lotta questions on a wide range of topics—from documentation best practices to setting a marketing budget. But one topic that comes up time and time again is what PTs can—or cannot—bill for. (And it makes a touch of sense considering that every PT practice relies on steady cash flow.)
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.
Okay, we’ll admit it: it’s probably the worst time of year to go camping. (It may not snow a whole lot in our lovely desert home, but even our December nights have gotten so, so bitterly cold.) But, that didn’t stop Heidi Jannenga, PT, DPT, ATC, WebPT Co-Founder and Chief Clinical Officer, and Rick Gawenda, PT, CEO of Gawenda Seminars & Consulting, from hosting an hour-long camping-themed webinar where they talked about ghost stories and s’mores—and a handful of CMS’s 2020 regulatory changes.
During this month’s webinar, compliance experts Heidi Jannenga, PT, DPT, ATC, WebPT Co-Founder and Chief Clinical Officer, and Veda Collmer, JD, OTR, WebPT’s Chief Compliance Officer, discussed strategies for contending with compliance chaos and Medicare mayhem.
Once upon a time, there was a clinic that never had a single denied claim or failed audit. This clinic prioritized ensuring compliance with Medicare rules and regulations just as much as delivering top-notch patient care and shipping clean claims.
Last July, we covered updated guidance on X modifier use from the Centers for Medicare and Medicare Services (CMS). As WebPT’s Erica McDermott explains, “beginning July 1, 2019, CMS will unbundle NCCI edit pairs when providers attach the appropriate modifier (59, XE, XS, XP, or XU) to either the first-column or second-column code (assuming, of course, that the situation warrants the use of one of these modifiers).”
Earlier this week, Heidi Jannenga, PT, DPT, ATC—WebPT’s Co-Founder and Chief Clinical Officer—and John Wallace, WebPT’s Chief Business Development Officer of Revenue Cycle Management, paired up to answer rehab therapists’ most burning billing questions during a live Q&A-style webinar.
Rehab therapy billing: It’s a total numbers game. Between CPT codes and billing modifiers, knowing which digits belong on a claim is no simple task. After all, rules seem to change with the seasons, and they often vary from payer to payer. Here on the WebPT Blog, we receive a lot of comments and queries in response to these ever-changing rules, and one of the hottest points of confusion these days is the difference between modifier 59 and modifier 25. When applied to CPT codes, both modifiers indica
We compiled an FAQ that answers rehab therapists’ most pressing questions about MIPS and the 2019 final rule.
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.
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 to change.
We received more than 600 questions during our Medicare open forum webinar. Here are the most common ones, along with answers.