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For therapists, coding can be complicated. And it gets even more complicated when modifiers enter the picture. Modifiers are tricky things. Used wisely, they can help maximize your revenue. But used erroneously, they can wreak havoc in the form of
In physical therapy the primary concern is treating the patient, and rightly so. But while it may not be the most important aspect of the job, getting paid should come at a very close second since it’s the only way
It’s time again to welcome the new year and with it, changes that will make our practices better than before. Among these changes? Physical Therapy codes.
Recently it was announced that the Physical Therapy Evaluation (97001) and Physical Therapy Re-evaluation (97002) codes have been deleted, and four new codes have been released in their place. These codes will be effective by January 1, 2017.
The new evaluation codes (97161 to 97163) center around services ranging in complexity from low to high, each with a code descriptor specifying required components. To give you an idea of each new code, some of the requirements are stated below:
Code no. 97161 – Physical therapy evaluation: low complexity, requiring the following components:
• A history with no personal factors and/or comorbidities that impact the plan of care;
• An examination of body system(s) using standardized tests and measures addressing 1-2 elements from any of the following: body structures and functions, activity limitations, and/or participation restrictions;
• A clinical presentation with stable and/or uncomplicated characteristics; and
• Clinical decision making of low complexity using standardized patient assessment instrument and/or measurable assessment of functional outcome.
In this case, usually 20 minutes are spent face-to-face with the patient and/or family.
Technology has penetrated practically every field and industry, and medical billing is no exception.
From training to application, technology has become part and parcel of medical billing and coding. There are online medical billing courses, virtual patient databases and electronic means of communicating with and billing patients. Yet some practices still feel apprehensive about embracing technology when it comes to billing, and their concerns would not be unfounded.
Common Concerns with Technology
The biggest and most common concern over the use of medical billing technology is security. In recent years, we’ve heard of numerous cases of hackers breaking into secure company databases, resulting in hundreds of sensitive and highly valuable client information being exposed to the public or going into the wrong hands.
Can you teach an old dog new tricks?
In the case of your current staff learning new ways to maximize your revenue, the answer is definitely yes.
But contrary to what may be implied in the title, maximizing your team to maximize revenue does not mean having your team work to the bone. It’s not just about working hard, it’s more about working smart. When you know how the modern revenue cycle works and what you and your team need to focus on within this cycle, your team can effectively maximize your revenue without much difficulty.
A More Effective Perspective to RCM
RCM or revenue cycle management is the healthcare industry’s financial process that typically starts the moment a patient contacts a medical practice and ends when a patient is discharged and payment is made. But within this cycle is a myriad of opportunities, opportunities to not only ensure that the current revenue cycle comes full circle, but that new ones can be started.
Is your practice constantly faced with the problem of under-coding?
Under-coding is defined as the process of medical coding wherein the codes used are not reflective of the full extent of treatment that the patient received. It is often the result of failing to abstract every code from the medical record or to select the highest specificity of codes. Like overcoding, it can lead to rejected or denied claims, not to mention decreased revenue. But under-coding can also lead to other, more serious problems, which is why it is crucial to avoid this mistake.
The Problem with Under-Coding
Despite resulting in lower revenues for practices, under-coding is still considered fraudulent and can lead to investigations or audits. Some coders think that under-coding is “playing it safe” when you’re unsure, but really it isn’t. It can be seen as inducement, or the practice of offering a free service to patients in order to encourage them to avail of a service that is covered by the insurance provider. This can lead to legal action on the grounds of fraud and abuse.
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