Sherry Marchand – 2018 Coding and Billing for Therapy and Rehab

Outline

CPT/HCPCS PROCEDURE CODES and COMPLIANCE WITH DOCUMENTATION STANDARDS

• Provides credentialing resources
• Explore the Revenue Cycle
• Evaluations and Re-Evaluations for Physical Therapy, Occupational Therapy and Speech Services. (Includes tools for changes in criteria.)
• Orders
• Plan of Care, Certification/Re-certification Rules Checklist
• CPT Procedure codes used in Therapy and Rehab
  • Evaluations, re-evaluations, and assessments
  • Supervised modalities
  • Guidelines for billing therapy minutes
  • Constant attendance modalities
  • Therapeutic procedures, included changes in orthotic and prosthetic management and training and development of cognitive skills
  • Speech Pathology Services
  • Neuromuscular procedures
  • Debridement, application of strapping, splints, casts
  • Using HCPCS Level II codes for DME
  • Orthotics billed by hospitals and other providers
  • Lymphedema Service
  • Woundcare
  • Physical Performance Testing
• Daily Session Note Checklist
• Discharge Checklist
• NCCI Edits
• Modifiers
• HCPCS II Procedure codes used in Therapy and Rehab
• Functional Limitation Requirements G-codes for functional limitations and severity modifiers – required for outpatient claims filed to Medicare
• Place of Service Codes

DIAGNOSTIC CODING

• New tools to prepare for ICD-10-CM – Bring your WI-FI enabled device
• Discuss chapters that effect Therapy and Rehab
• Laterality documentation requirements

FEDERAL REGULATIONS MEDICARE’S BILLING RULES and Special Payer News

• Medicare Therapy Cap
• Documentation to meet Medical Necessity in Therapy and Rehab
• Understand changes with congressional changes and their impact on Therapy and Rehab
• Understanding Value-Based Payment issues: (i.e. MACRA, MIPS and APM)
• Explore resources pertaining to CMS MAC, RAC, ZIP, and CERT program guidelines
• OIG audit focus on behavioral health services
• Medicare’s “incident to” guidelines, definition of “incident to” services vs payer supervision
• Overview of Commercial Plans and Therapy Coverage
• Common forms of health care fraud and abuse

COMPLIANCE

• Components of an effective compliance plan
• Understanding recent reports from CMS MAC, RAC, OIG, and GAO to reduce error rates in documentation

UNDERSTANDING THE REIMBURSEMENT PROCESS

• Understanding the claim content 837p and 837i resources
• Explore common revenue codes used with the 837i claims formats
• Learn about the Medicare Learning Network

THE APPEAL PROCESS

• Understanding reasons for denials
• Systematic steps of responding to an appeal
• Formats for appeal letters