Does anyone have a great resource for basic billing questions? I am trying to set up a business model for a small wellness Pilates based practice. I would rather not do a physician owned set up now but it might be my only good choice to get this started. Before I can make a decision I need to know a bit more about billing. Specifically, if I worked under the physician does the CPT codes fall under his number or mine? I read somewhere that only a licensed therapist can use the 97000's. How do POPTs bill? Thanks.
So many options but so little information! I am getting contradictory and incomplete information from many sources. Where is the gold standard in obtaining the information needed to make the right decisions? A reputable lawyer wasn't even helpful. Is there not a website or book that lays out the rules in a basic format? This should be public information. Thanks.
Joined: May 11, 2004
The Stark Law lays it out for you. No, an attorney won't be able to assist you until you specify the business model. Physical therapy services can be billed out "incident to." "Incident to" means "incident to" the physician's services. When that is the business model, the physician UPIN or soon NPI would be utilized. Physical therapy services can be provided in a physician owned clinic with the physical therapist PIN or NPI with reassignment of benefits to teh owners. My information was far from contradictory or incomplete... you have to know the business model. If you decide to practice in a physician owned clinic, you should very well knowledgeable of the Stark Law. If you read the definition of CPT codes as defined by the AMA, "physician" or "therapist" may use those codes. Granted, sometimes the services are provided by chiropractors, athletic trainers, aides/techs or assistants. So, you are inaccurate in the belief that 97000 codes as being physical therapist only codes.
I am sorry. I didn't mean to imply that you were contradictory or incomplete with your information. I was just referring to the process in general and some other specific sources that contradicted each other. You have been helpful and I appreciate it. Thank you again.