A Little Bit of This and a Little Bit of That: Billing and Payment 201
Section: Section on Health Policy & Administration
Co-Section: Private Practice Section
Session Code: HP-1B-4505
Date: Thursday, January 24, 2019
Time: 11:00 AM - 1:00 PM
Location: Walter E. Washington Convention Center
Room: 146C

Speaker(s):   Rick Gawenda, PT

Session Type: Educational Sessions
Session Level: Intermediate

This session will address multiple topics to increase physical therapists' understanding of billing and payment and how different policies impact their bottom financial line. The speaker will discuss how the monetary value of a CPT code is determined, payment rates for the most common CPT codes billed under a physical therapy plan of care, multiple procedure payment reduction policy, 2019 therapy cap dollar threshold and use of the KX modifier, use of the advance beneficiary notice of noncoverage for physical therapist services, and NCCI edits and the use of modifier 59. The speaker also will address the difference between Medicare's "8-minute rule" and the American Medical Association's definition of substantial,쳌 and how they each determine how many units can be billed for that visit.

Learning Objectives: Upon completion of this course, you will be able to:

1. Describe the process for how a CPT code obtains its monetary value under the Medicare Physician Fee Schedule.

2. Explain how the multiple procedure payment reduction policy reduces your payment.

3. Understand NCCI edits, the use of modifier 59 and how one discipline's billing can determine payment for another discipline's billing.

4. Recognize the difference between the "8-minute rule" and definition of substantial and how each impacts what you can bill.

CEU: 0.2

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