Medicare Billing

[Guest guest]

I have a private practice in Florida and have a billing question with Medicare.

To my

knowledge, a re-evaluation charge to Medicare has to wait at least 30 days

following the

initial evaluation. However, my question is the following: A patient was seen

for an initial

eval and discharged 2 weeks later. The following week, this patient sustained a

different

injury and presented with a prescription from his M.D. for physical therapy.

Since this patient

will be seen for 2 separate diagnosis, with one of them after the first was

discharged, am I

able to bill for an initial evaluation or a re-evaluation? My concern is that

the second

diagnosis/injury is within 30 days of the first one, which was already

discharged. Thank you

in advance.

Kramer P.T.

Pembroke Pines, FL

[Guest guest]

,

There is no Medicare rule that states a re-eval can't

be billed until the 30th day. Some state practice acts

may require re-evaluations at specific intervals.

Under Medicare, a re-eval is appropriate when the

professional assessment indicates a significant

improvement or decline in the patients condition or

functional status. In addition, you may bill another

eval for the new diagnosis. I have attached a link to

the Medicare Benefit Policy Manual. Please read the

definition of evaluation and re-evaluation on page

121-122.

http://www.cms.hhs.gov/manuals/Downloads/bp102c15.pdf

Rick Gawenda, PT

Director PM & R

Detroit Receiving Hospital

www.gawendaseminars.com

--- rk_jjk wrote:

> I have a private practice in Florida and have a

> billing question with Medicare. To my

> knowledge, a re-evaluation charge to Medicare has to

> wait at least 30 days following the

> initial evaluation. However, my question is the

> following: A patient was seen for an initial

> eval and discharged 2 weeks later. The following

> week, this patient sustained a different

> injury and presented with a prescription from his

> M.D. for physical therapy. Since this patient

> will be seen for 2 separate diagnosis, with one of

> them after the first was discharged, am I

> able to bill for an initial evaluation or a

> re-evaluation? My concern is that the second

> diagnosis/injury is within 30 days of the first one,

> which was already discharged. Thank you

> in advance.

>

> Kramer P.T.

> Pembroke Pines, FL

>

>

>

>

>

>

>

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