land WC Fee Schedule

[Guest guest]

Your State should have a dispute process that you must follow. Contact your

Work Comp commission or the Insurance Commission for guidance.

Bubba Klostermann OT, CVE, CEAS

President, WORK & REHAB

4546 South 14 th

Abilene, Texas 79605

phone:

fax:

email: bubklo@...

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[Guest guest]

A Few Question for land PTs and Administrators,

land's WC fee schedule changed to 109% of Medicare as of September 1, 2004.

1. Should E-stim be billed as G0283 now? I've noticed many recent denials on

97014.

2. Is the desending/cascading payment procedure still in effect? I've seen

duplicate codes denied.

3. Is Manual Therapy 97140 billable beyond one unit? I've seen mixed payments

here.

4. How can I appeal denials?

I feel like I'm playing a shell game here and losing $$$Thousands$$$

Any help is much appreciated. Also, I'm considering taking on a more active role

in the APTA of land with regard to reimbursement and other regulations. If

anyone has a suggested contact please let me know.

Many, many thanks in advance.

Frustrated in land,

B. Rohr, P.T.

[Guest guest]

,

The chair of the Reimbursement Committee is Sheila Schaffer and her e-mail is

sheilaschafferpt@....

B. Horn, PT, NCS

Research & Regulatory Compliance Coordinator

St. Agnes HealthCare

Baltimore, MD 21229

lhorn@...

>>> krohr1@... 11/10/04 06:41AM >>>

A Few Question for land PTs and Administrators,

land's WC fee schedule changed to 109% of Medicare as of September 1, 2004.

1. Should E-stim be billed as G0283 now? I've noticed many recent denials on

97014.

2. Is the desending/cascading payment procedure still in effect? I've seen

duplicate codes denied.

3. Is Manual Therapy 97140 billable beyond one unit? I've seen mixed payments

here.

4. How can I appeal denials?

I feel like I'm playing a shell game here and losing $$$Thousands$$$

Any help is much appreciated. Also, I'm considering taking on a more active role

in the APTA of land with regard to reimbursement and other regulations. If

anyone has a suggested contact please let me know.

Many, many thanks in advance.

Frustrated in land,

B. Rohr, P.T.

[Guest guest]

:

I _did not_ attend the most recent APTA of MD meeting which would

have granted the answer to many of these.

I will defer quickly to the OT named Bubba (I NEVER thought I would

say THAT!) and that he is aware that there are processes in place.

One day, you nad I are going to hang out together at a state PT

meeting, and together we will get our state association to help the

clinically practicing clinicians like us more effectively. While opn

the topic, each state ought to be doing the same.

Briefly, heavy loud opposition to this fee increase is being played

out by our orthopedic surgeon... who will face a HUGE decline in

payment. Thus, the fee schedule was delayed for many months, but the

9/1 date is valid. Keep in mind that there is NO incentive for the

WC compnay to follow that new fee schedule. So they might keep

paying on the cascading down system (diminishing returns payment

system)... I will forward your questions to the proper state

authorities, and am glad you voiced this issue. We have earned/

received a great favor, which is an improvement in WC payments. Oh,

watch out for the new 'contracts' that WC providers are offering us

to sign up with, ones that circumvent the new fee schedule.

Here goes:

land's WC fee schedule changed to 109% of Medicare as of

September 1, 2004. ---> and the natives rejoice!

1. Should E-stim be billed as G0283 now? I've noticed many recent

denials on 97014. ---> I do not know. I better look into this one!

On the topic, only ONE modality per visit will be paid. So the

HP/US/ES patient can get all three, but pays for only one.

2. Is the desending/cascading payment procedure still in effect? I've

seen duplicate codes denied. ---> No to the downward cascade. Not

sure on dupe coding ... BUT ... minutes are counted similar to

medicare - and it can be argued that mninutes matter for ALL CPTs

that are billed, but this is for another topic.

3. Is Manual Therapy 97140 billable beyond one unit? I've seen mixed

payments here. ---> I dont know. But what is a mixed payment? I am

thinking of mixed nuts, mixed nerves, but never a mixed payment.

4. How can I appeal denials? Agressively, quickly, persistently,

consistently, constantly, unforgivingly, and properly. r

first, then through the insurance commissioner.

I feel like I'm playing a shell game here and losing $$$Thousands$$$ -

--> Others mention the value of membership in the association. This

is a case where the association had shown its value, and now has the

chance to again demonstrate it. When APTA of MD is involved, it has

some clout and sway that individuals do NOT have. It is best to work

together for this common cause.

Peace

D. Simonetti, PT, DPT, MTC

Chief Physical Therapist, Chestertown Orthopedics and Sports Medicine

Instructor, Golo Sport and Spine I & II

http://www.golosport.com/es_sportSpineI_II.php#lo

> Bubba Klostermann OT, CVE, CEAS

> President, WORK & REHAB

> 4546 South 14 th

> Abilene, Texas 79605

> phone:

> fax:

> email: bubklo@a...

An OT named Bubba!