Objectives 

2018 Coding and Billing for Therapy and Rehab

Stay current with CPT, ICD-10-CM, and HCPCS Level II Codes.

Discover what must be done to comply with coding regulations and documentation standards. 

• New for 2018 Master changes to the Medicare Therapy Cap Exception process and how it will effect patient’s out of pocket expenses.
• New for 2018 Learn about orthotic and prosthetic management and training services by differentiating between initial and subsequent encounters.
• New for 2018 New CMS code for development of cognitive skills to improve attention, memory and problem solving.
• New for 2018 Master documentation elements, CPT coding and expected payment changes for Evaluations and Re-Evaluation codes for Physical and Occupational Therapy and Speech and Language Services.
• New for 2018 Be prepared for complicated MACRA law: Physical Therapists, Occupational Therapists and Speech and Language Pathologists have new 2019 reporting requirements for MIPS and APM bundled payments. Learn what is the best next steps for your organization.

Learn the most current and accurate coding procedures coupled with documentation tips and complete definitions to ensure prompt and optimal payments for future insurance claims.

Coding and Billing for Therapy and Rehab

Most current information will be covered

This course will equip Therapy and Rehab providers with an understanding of industry coding and billing changes that are needed to survive in this changing healthcare environment.

These topics include 2018 CPT, HCPCS and ICD-10-CM coding updates, effective billing, revenue and documentation techniques and best practices. Claims processing guidelines for 837p and 837i claim format. Prevent denials, delays and rejections by understanding how to combat these with effective appeals. Gain strategies for optimal reimbursement from Medicare, managed care, and insurance companies.

Denials, delays, and "more information required" are increasingly common responses for therapy and rehab insurance and Medicare claims. New codes and reimbursement policy changes have further complicated the claims process for physical and occupational therapists and facility-based rehabilitation providers. Effective Medicare and insurance billing requires a thorough understanding of coding, documentation and billing procedures. Consolidating all of the new requirements with existing coding rules and implementing proven billing techniques are the objectives of this seminar. Participants will learn the most current and accurate coding procedure coupled with documentation tips and new definitions to ensure prompt and optimal reimbursement on future claims.

Course Content

CPT/HCPCS PROCEDURE CODES and COMPLIANCE WITH DOCUMENTATION STANDARDS

• Provides credentialing resources
• Explore the Revenue Cycle
• Evaluations and Re-Evaluations for Physical Therapy, Occupational Therapy and Speech Services. (Includes tools for changes in criteria.)
  • New codes, new elements and easy-to-follow checklist
• Orders
• Plan of Care, Certification/Re-certification Rules Checklist
• CPT Procedure codes used in Therapy and Rehab
  • Evaluations, re-evaluations, and assessments
  • Supervised modalities
  • Guidelines for billing therapy minutes
  • Constant attendance modalities
  • Therapeutic procedures, included changes in orthotic and prosthetic management and training and development of cognitive skills
  • Speech Pathology Services
  • Neuromuscular procedures
  • Debridement, application of strapping, splints, casts
  • Using HCPCS Level II codes for DME
  • Orthotics billed by hospitals and other providers
  • Lymphedema Service
  • Woundcare
  • Physical Performance Testing 
• Daily Session Note Checklist
• Discharge Checklist

• NCCI Edits
• Modifiers
• HCPCS II Procedure codes used in Therapy and Rehab
• Functional Limitation Requirements G-codes for functional limitations and severity modifiers – required for outpatient   claims filed to Medicare
• Place of Service Codes

DIAGNOSTIC CODING 

            New tools to prepare for ICD-10-CM – Bring your WI-FI enabled device

            Discuss chapters that effect Therapy and Rehab

            Laterality documentation requirements

FEDERAL REGULATIONS  MEDICARE’S BILLING RULES and Special Payer News

• Medicare Therapy Cap
• Documentation to meet Medical Necessity in Therapy and Rehab
•  Understand changes with congressional changes and their impact on Therapy and Rehab
• Understanding Value-Based Payment issues: (i.e. MACRA, MIPS and APM)
• Explore resources pertaining to CMS MAC, RAC, ZIP, and CERT program guidelines
• OIG audit focus on behavioral health services 
• Medicare’s “incident to” guidelines, definition of “incident to” services vs payer supervision
• Overview of Commercial Plans and Therapy Coverage
• Common forms of health care fraud and abuse

COMPLIANCE

• Components of an effective compliance plan
• Understanding recent reports from CMS MAC, RAC, OIG, and GAO to reduce error rates in documentation

UNDERSTANDING THE REIMBURSEMENT PROCESS 

• Understanding the claim content 837p and 837i resources
• Explore common revenue codes used with the 837i claims formats
• Learn about the Medicare Learning Network 

THE APPEAL PROCESS 

• Understanding reasons for denials  
• Systematic steps of responding to an appeal
• Formats for appeal letters