The Merit-based Incentive Payment System, or MIPS, is one tough cookie. It’s complicated and downright frustrating at times—but it’s something that rehab therapists need to be familiar with. If you’ve been looking for a no-nonsense, easy-to-follow MIPS explainer, then you’ve come to the right place! Just play the video to understand the basics behind this latest government program.
Unless you’ve been intentionally avoiding all discussions of healthcare changes for 2017, you’ve probably heard at least mention of CMS’s Merit-Based Incentive Payment System (MIPS), which consolidates aspects of the Meaningful Use (MU), Physician Quality Reporting System (PQRS), and Value-Based Payment Modifier (VM) programs.
Here are answers to every question you’ve ever had about Medicare Part B for outpatient rehabilitation services.
If you have a physical therapy software that’s going out of business or is unreliable, then you face several problems as many regulatory changes hit.
With temperatures soaring—especially here in Phoenix—summertime is definitely upon us. That means you’re probably making family vacation plans, relaxing poolside, and doing a mid-year PQRS compliance audit—er, okay, maybe not that last one. But, in all seriousness, this is the perfect time of year to check your clinic’s PQRS compliancy.
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.
According to Merriam-Webster, a prediction is “a statement about what will happen or might happen in the future.” I don’t know about you, but when I think about what’s in store for our industry, I’m not satisfied with applying that definition to my hopes for the future. Why? Because I’m about more than just making statements; I’m about taking action.
Read up on the PQRS detail that could mean the difference between staying compliant and suffering financial penalties.
The details regarding PQRS 2016 have finally arrived; here’s what physical, occupational, and speech therapists need to know.
Here’s how data collection will influence your future payments—probably a lot more than you think.
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?