RE: Outpatient Medicare Billing Question

February 9, 2005

,

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

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February 10, 2005

In a message dated 2/10/2005 6:29:39 AM Central Standard Time,

markdwyer87@... writes:

> ,

>

> 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

>

My understanding, unless flawed is that an OP could not be billed for both a

group and 1:1 in the same tx session. Is this a correct understanding or am I

misunderstanding?

Thanks.

A. McKoy, PT, MS, GCS

njoy@Rest Haven Central

February 15, 2005

" ... everyone performing their individual program and your (sic) going from

person to person, correcting, demonstrating, etc. they are 1:1. "

Remember that Medicare is only reimbursing the average regional cost of your

own wage, not the intangible value that your patients received.

So, in the above scenario, they would be in 1:1 -- but only while you're

with that particular individual. At the end of an hour, Medicare only pays

for your single hour of time. Four patients at one unit each would be

legal, if you could prove (in writing) that you'd spent eight to 22 minutes

with each of them.

Also remember that Medicare's specific intention was to eliminate the

" High-Volume Sports Therapy " model of *charging* for care. Medicare's view

would be that if six or eight people are going to a place to have a vigorous

workout, it's like going to a club. So they pay like it's a health club.

Dick Hillyer, PT

Cape Coral, FL

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!

>

February 15, 2005