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Outpatient Business and Billing Practices

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Outpatient Business and Billing Practices - August 28, 2010 10:28:27 AM   


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New to outpatient.  Please help clarify as I am not heavily involved in the billing or payment acceptance.
1.  Can my employer accept reduced or waive copays for medicare and/or patient's with other insurance providers?  I have been assured that they have sought counsel with lawyers and believe that this is entirely allowable.
2.  Do medicare patients require one-on-one treatment or do you just use the "group" vs "individual" definitions to assist with charging?
3. Can techs do a list of hands-off exercises for medicare and/or other insurance providers?
If medicare, does that mean that the PT must be standing by the tech to supervise?
4. Which charges cannot be billed together?  
Post #: 1
RE: Outpatient Business and Billing Practices - August 28, 2010 1:56:39 PM   


Posts: 3332
Joined: May 11, 2004
From: Michigan
Status: offline
#1.  If your employer participates with an insurance company, your employer, by contract, is to bill the patient for deductibles and copays.  I believe the only way to reduce or waive is in the event of financial hardship - but you have to have a system/policy in place outlining/describing/defining the process to be followed in the event copays/deductibles are waived or reduced.  I believe there also has to be some sort of proof the system or policy defined by the PT company was followed.  It is not routine practice to just waive copays.

#2.  You charge the appropriate code for Medicare patients which defines the treatment provided.  Timed codes are one-on-one - if what appears to be a timed code occurs when more than one patient is being treated by the PT or PTA, then group code is the more appropriate code to use for the time that more than one patient is being treated at a time.

#3.  Medicare only allows a physical therapist or a physical therapist assistant to provide physical therapy services under Medicare part B regulations.  Other insurance payors may have different regulations.  Your state practice act also determines if or how supportive personnel are utilized for interventions.

#4.  You can bill anything you want together.  There are no rules on this.... insurance payors do have rules on some codes that are considered bundled.  Insurance payors also have some regulations on what ICD-9 codes are allowable for certain CPT codes. 

(in reply to dotksbgrace)
Post #: 2
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