RE: Outpatient Medicare Billing Question

[Guest guest]

,

I assume all of the codes you will use with the patients below are timed CPT

codes. As such, you would bill Patient A for whatever you did from 0800 -

0830 (e.g., gait, ther. ex., etc.), then a Group charge for the 0830 - 0845

slot. You would bill Patient B Group for his 0830 - 0845 slot, then bill

for whatever you did from 0845 - 0915 (e.g., manual therapy, ther. ex.,

etc.).

Mark Dwyer, PT, MHA

markdwyer87@...

Outpatient Medicare Billing Question

I have a question that has come up regarding Outpatient Medicare B Billing.

This is a scenario. Patient A has PT from 8:00 to 8:45. Patient B has PT

from 8:30 to 9:15. You are the PT seeing both these patients.

For the 15min over-lap, can you bill both patients for a 15min group in the

same session as their 1:1 time?

Thanks,

A. McKoy, PT, MS, GCS

njoy@Rest Haven Central

Looking to start your own Practice?

Visit www.InHomeRehab.com.

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and participate now!

[Guest guest]

Hi,

I just attended an APTA sponsored billing class in Dallas and they

offered the following scenario for determining 1:1 vs. group. If

you split up a room full of people and one half you told " okay I

want you guys to run on the treadmill 5 minutes, stop, take your

pulse then continue for 20 more minutes - that is group. If with

the other half of the room you have everyone performing their

individual program and your going from person to person, correcting,

demonstrating, etc. they are 1:1.

>

> ,

>

> I assume all of the codes you will use with the patients below are

timed CPT

> codes. As such, you would bill Patient A for whatever you did

from 0800 -

> 0830 (e.g., gait, ther. ex., etc.), then a Group charge for the

0830 - 0845

> slot. You would bill Patient B Group for his 0830 - 0845 slot,

then bill

> for whatever you did from 0845 - 0915 (e.g., manual therapy, ther.

ex.,

> etc.).

>

> Mark Dwyer, PT, MHA

> markdwyer87@c...

>

> Outpatient Medicare Billing Question

>

>

>

> I have a question that has come up regarding Outpatient Medicare B

Billing.

> This is a scenario. Patient A has PT from 8:00 to 8:45. Patient

B has PT

> from 8:30 to 9:15. You are the PT seeing both these patients.

>

> For the 15min over-lap, can you bill both patients for a 15min

group in the

> same session as their 1:1 time?

>

> Thanks,

>

> A. McKoy, PT, MS, GCS

> njoy@Rest Haven Central

>

>

>

>

>

>

> Looking to start your own Practice?

> Visit www.InHomeRehab.com.

> Bring PTManager to your organization or State Association with a

> professional workshop or course - call us at 313 884-8920 to

arrange

> PTManager encourages participation in your professional

association. Join

> and participate now!

>

[Guest guest]

Hi,

I just attended an APTA sponsored billing class in Dallas and they

offered the following scenario for determining 1:1 vs. group. If

you split up a room full of people and one half you told " okay I

want you guys to run on the treadmill 5 minutes, stop, take your

pulse then continue for 20 more minutes - that is group. If with

the other half of the room you have everyone performing their

individual program and your going from person to person, correcting,

demonstrating, etc. they are 1:1.

>

> ,

>

> I assume all of the codes you will use with the patients below are

timed CPT

> codes. As such, you would bill Patient A for whatever you did

from 0800 -

> 0830 (e.g., gait, ther. ex., etc.), then a Group charge for the

0830 - 0845

> slot. You would bill Patient B Group for his 0830 - 0845 slot,

then bill

> for whatever you did from 0845 - 0915 (e.g., manual therapy, ther.

ex.,

> etc.).

>

> Mark Dwyer, PT, MHA

> markdwyer87@c...

>

> Outpatient Medicare Billing Question

>

>

>

> I have a question that has come up regarding Outpatient Medicare B

Billing.

> This is a scenario. Patient A has PT from 8:00 to 8:45. Patient

B has PT

> from 8:30 to 9:15. You are the PT seeing both these patients.

>

> For the 15min over-lap, can you bill both patients for a 15min

group in the

> same session as their 1:1 time?

>

> Thanks,

>

> A. McKoy, PT, MS, GCS

> njoy@Rest Haven Central

>

>

>

>

>

>

> Looking to start your own Practice?

> Visit www.InHomeRehab.com.

> Bring PTManager to your organization or State Association with a

> professional workshop or course - call us at 313 884-8920 to

arrange

> PTManager encourages participation in your professional

association. Join

> and participate now!

>

[Guest guest]

Hi,

I just attended an APTA sponsored billing class in Dallas and they

offered the following scenario for determining 1:1 vs. group. If

you split up a room full of people and one half you told " okay I

want you guys to run on the treadmill 5 minutes, stop, take your

pulse then continue for 20 more minutes - that is group. If with

the other half of the room you have everyone performing their

individual program and your going from person to person, correcting,

demonstrating, etc. they are 1:1.

>

> ,

>

> I assume all of the codes you will use with the patients below are

timed CPT

> codes. As such, you would bill Patient A for whatever you did

from 0800 -

> 0830 (e.g., gait, ther. ex., etc.), then a Group charge for the

0830 - 0845

> slot. You would bill Patient B Group for his 0830 - 0845 slot,

then bill

> for whatever you did from 0845 - 0915 (e.g., manual therapy, ther.

ex.,

> etc.).

>

> Mark Dwyer, PT, MHA

> markdwyer87@c...

>

> Outpatient Medicare Billing Question

>

>

>

> I have a question that has come up regarding Outpatient Medicare B

Billing.

> This is a scenario. Patient A has PT from 8:00 to 8:45. Patient

B has PT

> from 8:30 to 9:15. You are the PT seeing both these patients.

>

> For the 15min over-lap, can you bill both patients for a 15min

group in the

> same session as their 1:1 time?

>

> Thanks,

>

> A. McKoy, PT, MS, GCS

> njoy@Rest Haven Central

>

>

>

>

>

>

> Looking to start your own Practice?

> Visit www.InHomeRehab.com.

> Bring PTManager to your organization or State Association with a

> professional workshop or course - call us at 313 884-8920 to

arrange

> PTManager encourages participation in your professional

association. Join

> and participate now!

>

[Guest guest]

And if you throw a Part B into the mix, the Part B will only be group

unless treated one-on-one the entire time.

" G "

Outpatient Medicare Billing Question

> >

> >

> >

> > I have a question that has come up regarding Outpatient Medicare B

> Billing.

> > This is a scenario. Patient A has PT from 8:00 to 8:45. Patient

> B has PT

> > from 8:30 to 9:15. You are the PT seeing both these patients.

> >

> > For the 15min over-lap, can you bill both patients for a 15min

> group in the

> > same session as their 1:1 time?

> >

> > Thanks,

> >

> > A. McKoy, PT, MS, GCS

> > njoy@Rest Haven Central

> >

> >

> >

> >

> >

> >

> > Looking to start your own Practice?

> > Visit www.InHomeRehab.com.

> > Bring PTManager to your organization or State Association with a

> > professional workshop or course - call us at 313 884-8920 to

> arrange

> > PTManager encourages participation in your professional

> association. Join

> > and participate now!

> >

[Guest guest]

Yes, this is correct. Medicare A allows for dovetailing, supervision, etc.

" G "

Outpatient Medicare Billing Question

> >

> >

> >

> > I have a question that has come up regarding Outpatient Medicare B

> Billing.

> > This is a scenario. Patient A has PT from 8:00 to 8:45. Patient

> B has PT

> > from 8:30 to 9:15. You are the PT seeing both these patients.

> >

> > For the 15min over-lap, can you bill both patients for a 15min

> group in the

> > same session as their 1:1 time?

> >

> > Thanks,

> >

> > A. McKoy, PT, MS, GCS

> > njoy@Rest Haven Central

> >

> >

> >

> >

> >

> >

> > Looking to start your own Practice?

> > Visit www.InHomeRehab.com.

> > Bring PTManager to your organization or State Association with a

> > professional workshop or course - call us at 313 884-8920 to

> arrange

> > PTManager encourages participation in your professional

> association. Join

> > and participate now!

> >

[Guest guest]

Knowing the presenters of these seminats as I do, and knowing the content of

what they present, I suspect that you may have misinterpreted what was said.

There seems to be continued confusion about this issue, and it has been our

observation that there are 2 glaring misconceptions responsible for the

majority of this confusion.

1-CPT codes are intended to describe services that we provide to patients,

not to describe what patients " are doing " .

2-There is no CPT code for " supervised exercise " .

If we can be clear on these two concepts, I think that it will alleviate a

lot of coding confusion.

Ken Mailly, PT

Mailly & Inglett Consulting, LLC

Tel. 973 692-0033

Fax 973 633-9557

68 Seneca Trail

Wayne, NJ, 07470

www.NJPTAid.biz

Bridging the Gap!

Outpatient Medicare Billing Question

>

>

>

> I have a question that has come up regarding Outpatient Medicare B

Billing.

> This is a scenario. Patient A has PT from 8:00 to 8:45. Patient

B has PT

> from 8:30 to 9:15. You are the PT seeing both these patients.

>

> For the 15min over-lap, can you bill both patients for a 15min

group in the

> same session as their 1:1 time?

>

> Thanks,

>

> A. McKoy, PT, MS, GCS

> njoy@Rest Haven Central

>

>

>

>

>

>

> Looking to start your own Practice?

> Visit www.InHomeRehab.com.

> Bring PTManager to your organization or State Association with a

> professional workshop or course - call us at 313 884-8920 to

arrange

> PTManager encourages participation in your professional

association. Join

> and participate now!

>

[Guest guest]

The rules are different for MedA and MedB. CMS has posted a detailed

explanation with scenarios for billing for group therapy at

http://www.cms.hhs.gov/medlearn/therapy/. They actually used the scenarios

developed by Helene Fearon which are also posted in the APTA web site under the

reimbursement or government affairs heading.

Cheryl Dix, MS, PT

Outpatient Medicare Billing Question

> >>

> >>

> >>

> >> I have a question that has come up regarding Outpatient

Medicare B

> > Billing.

> >> This is a scenario. Patient A has PT from 8:00 to 8:45.

Patient

> > B has PT

> >> from 8:30 to 9:15. You are the PT seeing both these patients.

> >>

> >> For the 15min over-lap, can you bill both patients for a 15min

> > group in the

> >> same session as their 1:1 time?

> >>

> >> Thanks,

> >>

> >> A. McKoy, PT, MS, GCS

> >> njoy@Rest Haven Central

> >>

> >>

> >>

> >>

> >>

> >>

> >> Looking to start your own Practice?

> >> Visit www.InHomeRehab.com.

> >> Bring PTManager to your organization or State Association with a

> >> professional workshop or course - call us at 313 884-8920 to

> > arrange

> >> PTManager encourages participation in your professional

> > association. Join

> >> and participate now!

> >>

[Guest guest]

The rules are different for MedA and MedB. CMS has posted a detailed

explanation with scenarios for billing for group therapy at

http://www.cms.hhs.gov/medlearn/therapy/. They actually used the scenarios

developed by Helene Fearon which are also posted in the APTA web site under the

reimbursement or government affairs heading.

Cheryl Dix, MS, PT

Outpatient Medicare Billing Question

> >>

> >>

> >>

> >> I have a question that has come up regarding Outpatient

Medicare B

> > Billing.

> >> This is a scenario. Patient A has PT from 8:00 to 8:45.

Patient

> > B has PT

> >> from 8:30 to 9:15. You are the PT seeing both these patients.

> >>

> >> For the 15min over-lap, can you bill both patients for a 15min

> > group in the

> >> same session as their 1:1 time?

> >>

> >> Thanks,

> >>

> >> A. McKoy, PT, MS, GCS

> >> njoy@Rest Haven Central

> >>

> >>

> >>

> >>

> >>

> >>

> >> Looking to start your own Practice?

> >> Visit www.InHomeRehab.com.

> >> Bring PTManager to your organization or State Association with a

> >> professional workshop or course - call us at 313 884-8920 to

> > arrange

> >> PTManager encourages participation in your professional

> > association. Join

> >> and participate now!

> >>