Guest guest Posted April 28, 1999 Report Share Posted April 28, 1999 <05256761.005008a7.0-qh_ntprox (DOT) quorumhealth.com> wrote: Original Article: /list/ptmanager/?start=5103 > I have a few charging questions for the group relating to timed charges. > Background Info: Our charging formula for timed charges is based on > rounding to the nearest unit in the code description. > 1 - 7 minutes no charge > (ex. attempt to see patient and he/she refuses) > 8 - 15 minutes 1 unit > 16 - 22 minutes 1 unit > 23 - 30 minutes 2 units > etc. > Questions: My questions are as follows: > 1. Is rounding to the nearest unit the correct > formula to be utilizing? I know many other facilities do not use this > method. > 2. Does anyone use modifier -52 (reduces services) > when the total time of treatment does not equal the stated > units in the code description? > 3. Is it fraudulent to see a patient for less than > 8 minutes (in our case), document and not submit a charge? > One of the staff therapists had heard that it > is fraudulent even if the patient refused or treatment began and > then stopped due to patient's tolerance, etc. > > Thank you in advance! > Lorie Ailor, MS,OTR > Lutheran Hospital of Indiana > > > I worked for a facility that billed like th plummer did. charge for the documentation, go into the additional unit (by five minutes) and charge the additional unit. BUT, then I went on my own, read the regs, and learned the rules, as per HCFA's guidelines. You aren't supposed to charge for a unit unless you've used the entire unit. And billing for documentation isn't acceptable. That leads me to believe that your biling is better than what this other facility was doing, but not quite up to snuff per HCFA. And leads me to another 'Q'... how does a PT report their prior indiscretions? thanks, ------------------------------------------------------------------------ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 28, 1999 Report Share Posted April 28, 1999 I recently attended a coding course that had Medicare Representatives present. They presented that you could not charge for a timed unit if it took less than 8 minutes. The example that they gave was that if you did an Ultrasound for 6 minutes or less, then you cannot charge for this. This course was presented by Steve Levine. Many of us in the audience had significant concerns regarding this, however, the Medicare representative also defined timed units this way. a Burnett, PT Jefferson City, MO Re: Timed Charges Lorie - Concerning rounding of charges: My understanding of the " unit " process is that it is: 01-15 minutes = 1 unit 16-30 minutes = 2 unit 31-45 minutes = 3 units 46-60 minutes = 4 units (Employee payroll timeclock systems do what you described, ....but that's not how your professional patient charge system works. Those charges (if collected) are what pays your staff.) No provision is made to break the hour down to further subdivisions. Any number which is greater than 01 but is equal to or less than 15 minutes is one unit, and so on. If your therapist goes to a patient room and the patient is only able to work for 4 or 9 or 14 minutes, the charge is " 1 Unit " -- If they were to work for 32 or 39 or 44 minutes, the If your staffer sees a patient for less than 8 minutes and does not submit a charge, it is the same as if they stole some roses from the gift shop and just gave them to the patient. It may not be " fraud " as it is defined, but the reverse. It should be seen as theft. Employees do not really have the latitude to " give away " professional services unless it is authorized by the employer. If the patient refuses treatment before the staffer begins, there was no service provided, so there should be no charge. If they refuse further treatment at any time, the staffer should record the visit according to the minutes of service which were actually provided. It's simple: Write it down the way it actually happened. Again, my 2c. Dick Hillyer, PT ------------------------------------------------------------------------ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 29, 1999 Report Share Posted April 29, 1999 What (properly done) ultrasound treatment takes less than 8 minutes? After all, you have to properly position the patient, expose the area to be treated, drape the patient, explain the procedure, apply the coupling agent, turn on the machine, bring it up to therapeutic intensity, do the treatment (at least 5 minutes in the majority of cases), wipe off the coupling agent, clean the skin....yada, yada.....unless the procedure was done in a substandared way, I think we should all feel comfortable charging for providing an ultrasound treatment. Perhaps HCFA has some suggestions about the specs for the stopwatches we purchase for our clinical staff to use to time their care?! E. Arslanian, MS, PT Director of Rehabilition Services Brigham & Women's Hospital Boston, MA > Re: Timed Charges > > " ...They presented that you could not charge for a timed unit if > it took less than 8 minutes. The example that they gave was that if > you > did an Ultrasound for 6 minutes or less, then you cannot charge for > this... " > > Wow. I'm ...shocked. Stunned. Outraged. > > ...But somehow, not surprised. > > > Thanx for the revelation! > > Dick Hillyer, PT > > > ---------------------------------------------------------------------- > -- > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 29, 1999 Report Share Posted April 29, 1999 a, Good to see you on the list. Are you planning on attending the candidates training at the APTA June conference? I think this would be good preperation for your run for the MO House. Our PAC would pay the registration and maybe the MPTA could come up with some $$ for travel etc. Chuck Re: Timed Charges Lorie - Concerning rounding of charges: My understanding of the " unit " process is that it is: 01-15 minutes = 1 unit 16-30 minutes = 2 unit 31-45 minutes = 3 units 46-60 minutes = 4 units (Employee payroll timeclock systems do what you described, ....but that's not how your professional patient charge system works. Those charges (if collected) are what pays your staff.) No provision is made to break the hour down to further subdivisions. Any number which is greater than 01 but is equal to or less than 15 minutes is one unit, and so on. If your therapist goes to a patient room and the patient is only able to work for 4 or 9 or 14 minutes, the charge is " 1 Unit " -- If they were to work for 32 or 39 or 44 minutes, the If your staffer sees a patient for less than 8 minutes and does not submit a charge, it is the same as if they stole some roses from the gift shop and just gave them to the patient. It may not be " fraud " as it is defined, but the reverse. It should be seen as theft. Employees do not really have the latitude to " give away " professional services unless it is authorized by the employer. If the patient refuses treatment before the staffer begins, there was no service provided, so there should be no charge. If they refuse further treatment at any time, the staffer should record the visit according to the minutes of service which were actually provided. It's simple: Write it down the way it actually happened. Again, my 2c. Dick Hillyer, PT ------------------------------------------------------------------------ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 29, 1999 Report Share Posted April 29, 1999 Lorie - Concerning rounding of charges: My understanding of the " unit " process is that it is: 01-15 minutes = 1 unit 16-30 minutes = 2 unit 31-45 minutes = 3 units 46-60 minutes = 4 units (Employee payroll timeclock systems do what you described, ...but that's not how your professional patient charge system works. Those charges (if collected) are what pays your staff.) No provision is made to break the hour down to further subdivisions. Any number which is greater than 01 but is equal to or less than 15 minutes is one unit, and so on. If your therapist goes to a patient room and the patient is only able to work for 4 or 9 or 14 minutes, the charge is " 1 Unit " -- If they were to work for 32 or 39 or 44 minutes, the If your staffer sees a patient for less than 8 minutes and does not submit a charge, it is the same as if they stole some roses from the gift shop and just gave them to the patient. It may not be " fraud " as it is defined, but the reverse. It should be seen as theft. Employees do not really have the latitude to " give away " professional services unless it is authorized by the employer. If the patient refuses treatment before the staffer begins, there was no service provided, so there should be no charge. If they refuse further treatment at any time, the staffer should record the visit according to the minutes of service which were actually provided. It's simple: Write it down the way it actually happened. Again, my 2c. Dick Hillyer, PT ------------------------------------------------------------------------ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 29, 1999 Report Share Posted April 29, 1999 , It has been my experience that Medicare doesn't recognize set up and tear down as part of the treatment. Yes, I and I think most others agree that when correctly performed it takes a good 15 minutes to perform the treatment from set up to clean up. The problem arises when we document. Yes the procedure required 1 unit of our time (12-15 minutes) however we don't document US @ 1.2 w/cm2 3MHz for 15 minutes, we do document US @ 1.2 w/cm2 3MHz for 6 minutes so they reimburse for the actual treatment time of the US not the amount of time that it took us to perform the procedure. Perhaps that is where the misinformation lies. Again it comes back to us educating others on what we do and what skill level it takes to perform different tasks related to physical therapy even including set ups and tear downs. When I do a set up or a tear down I am also assessing so I feel that if I do the procedure then it is skilled and all of the time is valuable. Is that the same if an aide does the set up and tear down? In the recent past we may have done our profession a disservice by providing quantity instead of quality and standing by while administrations forced the use of aides well outside of their role. It is so important that we critically look at what we are doing today and everyday and ask what will the consequences of these actions be tomarrow. Who would've known that in the 80's when the profession was struggling to meet the needs of the public with a shortage of staff and dovetailling patients and having aides set up and tear down procedures that that could set a precedence for non payment in the future. I'll step off my soap box now. Thanks. Jamyne PT, ACCE MSU College of Technology - Great Falls P.O. Box 6010 Great Falls, MT 59406 Phone # Fax # email> jrichardson@... Re: Timed Charges > > " ...They presented that you could not charge for a timed unit if > it took less than 8 minutes. The example that they gave was that if > you > did an Ultrasound for 6 minutes or less, then you cannot charge for > this... " > > Wow. I'm ...shocked. Stunned. Outraged. > > ...But somehow, not surprised. > > > Thanx for the revelation! > > Dick Hillyer, PT > > > ---------------------------------------------------------------------- > -- > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 29, 1999 Report Share Posted April 29, 1999 Another person weighing in on charging. Seems like a lot of people have a lot of strong opinions about this... Re: Timed Charges > > " ...They presented that you could not charge for a timed unit if > it took less than 8 minutes. The example that they gave was that if > you > did an Ultrasound for 6 minutes or less, then you cannot charge for > this... " > > Wow. I'm ...shocked. Stunned. Outraged. > > ...But somehow, not surprised. > > > Thanx for the revelation! > > Dick Hillyer, PT > > > ---------------------------------------------------------------------- > -- > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 29, 1999 Report Share Posted April 29, 1999 This should not be a discussion of passion but rather one of fact. Does anyone have references to back up one position or the other. I think we all are frustrated, but what is actually required? At 12:23 PM 4/29/99 , you wrote: Another person weighing in on charging. Seems like a lot of people have a lot of strong opinions about this... -----Original Message----- From: Jamyne [sMTP:jrichardson@...] Sent: Thursday, April 29, 1999 10:54 AM To: 'ptmanageregroups' Subject: Re: Timed Charges , It has been my experience that Medicare doesn't recognize set up and tear down as part of the treatment. Yes, I and I think most others agree that when correctly performed it takes a good 15 minutes to perform the treatment from set up to clean up. The problem arises when we document. Yes the procedure required 1 unit of our time (12-15 minutes) however we don't document US @ 1.2 w/cm2 3MHz for 15 minutes, we do document US @ 1.2 w/cm2 3MHz for 6 minutes so they reimburse for the actual treatment time of the US not the amount of time that it took us to perform the procedure. Perhaps that is where the misinformation lies. Again it comes back to us educating others on what we do and what skill level it takes to perform different tasks related to physical therapy even including set ups and tear downs. When I do a set up or a tear down I am also assessing so I feel that if I do the procedure then it is skilled and all of the time is valuable. Is that the same if an aide does the set up and tear down? In the recent past we may have done our profession a disservice by providing quantity instead of quality and standing by while administrations forced the use of aides well outside of their role. It is so important that we critically look at what we are doing today and everyday and ask what will the consequences of these actions be tomarrow. Who would've known that in the 80's when the profession was struggling to meet the needs of the public with a shortage of staff and dovetailling patients and having aides set up and tear down procedures that that could set a precedence for non payment in the future. I'll step off my soap box now. Thanks. Jamyne PT, ACCE MSU College of Technology - Great Falls P.O. Box 6010 Great Falls, MT 59406 Phone # Fax # email> jrichardson@... -----Original Message----- From: Arslanian, E. Sent: Thursday, April 29, 1999 5:55 AM To: 'ptmanageregroups' Subject: Re: Timed Charges What (properly done) ultrasound treatment takes less than 8 minutes? After all, you have to properly position the patient, expose the area to be treated, drape the patient, explain the procedure, apply the coupling agent, turn on the machine, bring it up to therapeutic intensity, do the treatment (at least 5 minutes in the majority of cases), wipe off the coupling agent, clean the skin....yada, yada.....unless the procedure was done in a substandared way, I think we should all feel comfortable charging for providing an ultrasound treatment. Perhaps HCFA has some suggestions about the specs for the stopwatches we purchase for our clinical staff to use to time their care?! E. Arslanian, MS, PT Director of Rehabilition Services Brigham & Women's Hospital Boston, MA > Re: Timed Charges > > " ...They presented that you could not charge for a timed unit if > it took less than 8 minutes. The example that they gave was that if > you > did an Ultrasound for 6 minutes or less, then you cannot charge for > this... " > > Wow. I'm ...shocked. Stunned. Outraged. > > ....But somehow, not surprised. > > > Thanx for the revelation! > > Dick Hillyer, PT > > > ---------------------------------------------------------------------- > -- > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 29, 1999 Report Share Posted April 29, 1999 Jamyne; When I was talking about setting up/tear down, I was not referring to changing the linens, cleaning the sounds heads, putting the aquasonic back into the warmer....you get my meaning, but in the professional aspects of that treatment that you describe so well below. Specifically, the positioning of the patient before and during the actual procedure itself, the palpation of the body part to plan and verify where to do the U.S....etc. The trouble comes when we document the " dosage " of the actual treatment, (e.g. the intensity X the time). To a fiscal intermediary, or HCFA agent we've just documented the actual time of the treatment. After all, we are identified as a technical prescriptive service in their eyes. So you're right. We as always, have lots of education to do if we ever hope that one day a payer or fiscal intermediary would understand that " 1.5 w/cm2 x 5 min. " does not mean that the patient received a total of 5 minutes of treatment..... E. Arslanian, MS, PT Director of Rehabilition Services Brigham & Women's Hospital Boston, MA > Re: Timed Charges > > > > " ...They presented that you could not charge for a timed unit if > > it took less than 8 minutes. The example that they gave was that if > > you > > did an Ultrasound for 6 minutes or less, then you cannot charge for > > this... " > > > > Wow. I'm ...shocked. Stunned. Outraged. > > > > ...But somehow, not surprised. > > > > > > Thanx for the revelation! > > > > Dick Hillyer, PT > > > > > > > ---------------------------------------------------------------------- > > -- > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 29, 1999 Report Share Posted April 29, 1999 What are the dates? I think you would be a better representative - you have the suits for it! Re: Timed Charges Lorie - Concerning rounding of charges: My understanding of the " unit " process is that it is: 01-15 minutes = 1 unit 16-30 minutes = 2 unit 31-45 minutes = 3 units 46-60 minutes = 4 units (Employee payroll timeclock systems do what you described, ...but that's not how your professional patient charge system works. Those charges (if collected) are what pays your staff.) No provision is made to break the hour down to further subdivisions. Any number which is greater than 01 but is equal to or less than 15 minutes is one unit, and so on. If your therapist goes to a patient room and the patient is only able to work for 4 or 9 or 14 minutes, the charge is " 1 Unit " -- If they were to work for 32 or 39 or 44 minutes, the If your staffer sees a patient for less than 8 minutes and does not submit a charge, it is the same as if they stole some roses from the gift shop and just gave them to the patient. It may not be " fraud " as it is defined, but the reverse. It should be seen as theft. Employees do not really have the latitude to " give away " professional services unless it is authorized by the employer. If the patient refuses treatment before the staffer begins, there was no service provided, so there should be no charge. If they refuse further treatment at any time, the staffer should record the visit according to the minutes of service which were actually provided. It's simple: Write it down the way it actually happened. Again, my 2c. Dick Hillyer, PT ------------------------------------------------------------------------ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 29, 1999 Report Share Posted April 29, 1999 " ...They presented that you could not charge for a timed unit if it took less than 8 minutes. The example that they gave was that if you did an Ultrasound for 6 minutes or less, then you cannot charge for this... " Wow. I'm ...shocked. Stunned. Outraged. ...But somehow, not surprised. Thanx for the revelation! Dick Hillyer, PT ------------------------------------------------------------------------ Quote Link to comment Share on other sites More sharing options...
Recommended Posts
Join the conversation
You are posting as a guest. If you have an account, sign in now to post with your account.
Note: Your post will require moderator approval before it will be visible.