therapy cap Archives | WebPT

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Over the Line: 4 Times When It’s Okay to Treat a Medicare Patient Beyond the Therapy Threshold

The #spookyszn has come and gone, but for many physical therapists, the threat of a Medicare audit is far more frightening than any ghoul or goblin—no matter what time of year it is. As such, some PTs may try to subvert the ever-watchful eye of CMS by remaining cautious as their patients creep closer to the Medicare physical therapy threshold (formerly known as the “Medicare physical therapy cap”).

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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.

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When to Use the KX Modifier

In the months since the elimination of the hard cap on therapy services, it seems like rehab therapists are more confused than ever about when they should affix the KX modifier versus issue an Advance Beneficiary Notice of Noncoverage (ABN). The truth of the matter is that not much has changed operationally since the Medicare therapy cap repeal—aside from the name of the cap (i.e., what was once the “hard cap” is now called the “soft cap” or “threshold”).

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Denial Management FAQ

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.

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The Complete PT Billing FAQ

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:

• WebPT
• Modifier 59
• Other Modifiers
• Coding
• ICD-10
• Advance Beneficiary Notice (ABN) of Noncoverage
• Claims
• Contracts and Fee Schedules
• 8-Minute Rule
• Functional Limitation Reporting
• Cash-Pay Patients

WebPT

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).

  1. Select “Display Insurance,” located on the left side of the WebPT Dashboard.
  2. Click “Edit” on the individual insurance for which you want to activate the feature.
  3. 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.

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Do You Know Your PT Billing Blunders? [Quiz]

Billing for physical therapy services is tricky, time-consuming, and nerve-racking. After all, there are so many rules you have to follow, and it seems like those rules are constantly changing. That makes mistakes tough to avoid.

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