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Double Booking/Billing is it ethical/legal?

 
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Double Booking/Billing is it ethical/legal? - August 21, 2018 9:37:29 PM   
TomCPT

 

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If you have 2 patients scheduled for an hour at the same time, for example 8-9am (double booked), are you allowed to bill 4 timed units (60 min) to each patient? So patient A would get 4 units and patient B would also get 4 units.

From my understanding of AMA CPT codes if we are charging therapeutic procedures such as ther ex, ther act, gait, neuro re-ed, all of theses codes are supposed to be one-on-one. So I don't understand how some clinics are getting away with charging 4 timed units in an hour block for each patient. I know the clinics that are doing this are doing so with commercial payers and not federal payers.

Is there some loophole that I am not aware of because the CPT codes are written by AMA not CMS so they apply to both commercial and federal payers?
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RE: Double Booking/Billing is it ethical/legal? - August 22, 2018 9:11:56 AM   
Tom Reeves DPT ATC

 

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Joined: March 15, 2006
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No, its neither legal or IMO ethical. the most you can bill each is a total of 60 minutes. I believe that there is a group therapy code but it is much lower. We never use it.

(in reply to TomCPT)
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RE: Double Booking/Billing is it ethical/legal? - September 27, 2018 12:12:28 PM   
aR3Vk

 

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Check the billing regulations of commercial insurers.

https://www.webpt.com/blog/post/one-on-one-services-vs-group-services

http://www.apta.org/Payment/Coding/GroupTherapyScenarios/

(in reply to TomCPT)
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