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Who should attend Outpatient Therapy: CPT Coding, Billing and Documentation for Rehabilitation Reimbursement
If you provide outpatient therapy services or work for an agency or facility that does, this seminar is for you.
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Outpatient Therapy: CPT Coding, Billing and Documentation for Rehabilitation Reimbursement  

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If you provide outpatient therapy services or work for an agency or facility that does, this seminar is for you.

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Seminar Summary:

Stay up-to-date on outpatient therapy services' guidelines and regulations (see full course description)

 
 

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Training Course Syllabus:


Outpatient Therapy: CPT Coding, Billing and Documentation for Rehabilitation Reimbursement - Healthcare Seminar

Discover common reasons claims are denied and how to ensure outpatient therapy rehabilitation reimbursement through proper coding and billing.

If you provide outpatient therapy services or work for an agency or facility that does, this seminar is for you. In just one day of powerful training, you will gain the skills, tools and techniques necessary for proper compliance with all outpatient coding, billing and documentation rules, regulations and guidelines.

This seminar provides the skills, tools and knowledge you need to minimize the potential of claim denial, use appropriate coding in every situation and keep documentation (including initial evaluations, re-evaluations, progress reports, daily notes, certifications/re-certifications, plans of treatment and physician orders) in line with current CMS guidelines.

Here is just some of what we'll cover in this powerful day of rehabilitation reimbursement training:

  • Coverage and reimbursement criteria for licensed therapists in private practice
  • A briefing of the history of changes and reasons for stringent audit efforts
  • The latest CMS rules and regulations affecting outpatient therapy services
  • How to identify and avoid the most common reasons carriers deny claims
  • How to pinpoint and mitigate red flags that could trigger an RAC audit
  • Master the appropriate use of CPT and G&L II codes
  • What to do first, how to prepare and what to expect during an audit
  • Gain a complete understanding of the ICD-9-CM coding guidelines pertaining to outpatient therapy
  • When to use Modifier-KX and when not to
  • Learn to append modifiers to the correct CPT codes and use documentation to support the use of Modifier-59
  • Develop a complete care plan and ensure certification and re-certification guidelines are met
  • And much, much more!

This intensive, focused training is designed to provide an incredible amount of information in just one power-packed day. Your trainer is an expert in the rehabilitation reimbursement and regulations field, and you'll be able to gain answers to your thorniest questions and most challenging coding and billing scenarios.

Outpatient Therapy: CPT Coding, Billing and Documentation for Rehabilitation Reimbursement Seminar Overview

Part One: Therapy Performed by Licensed Therapists in Private Practice

  • Questionable billing practices that may indicate fraud
  • OIG recommendations for solving fraudulent billing practices
  • Coverage and reimbursement criteria for outpatient therapy services
  • Common reasons for denial of claims submitted by a practice
  • Criteria for therapy overseen or provided by a Physician or Non-Physician Practitioner (NPP)

Part Two: Conditions of Coverage

  • Establishing the plan
  • Certification and re-certification
  • Delayed certification — when is it permissible?
  • Denials due to certification issues
  • Proper documentation guidelines
  • Evaluations
  • Re-evaluations
  • Progress reports

Part Three: CPT, Level II HCPCS Codes and Modifiers

  • Timed and untimed code-reporting requirements
  • Local Coverage Determination Policies (LCDs)
  • Determining what time counts toward 15-minute time codes — all claims
  • Correct use of G and L codes
  • Evaluation and Management (E/M) Modifiers
  • Additional HCPCS codes
  • National Correct Coding Initiative (NCCI)
  • Medically unlikely edits
  • Proper use of Modifier-59

Part Four: The Therapy Cap and Other Coverage Limitations

  • Outpatient therapy caps
  • Exceptions to therapy caps
  • Automatic and manual process for exceptions
  • Exceptions for evaluation services
  • Additional considerations for exceptions
  • Appeals process
  • KX Modifier for therapy-cap exceptions
  • Progressive Corrective Action (PCA) and medical review
  • Provider notification for beneficiaries exceeding therapy limits
  • Advance Beneficiary Notice of Non-coverage (ABN)
  • General Physical Medicine and Rehabilitation (PM&R) Guidelines
  • Maintenance therapy guidelines
  • Specific modality guidelines
  • General guidelines for therapeutic procedures (97110-97546)
  • Utilization guidelines
  • Multiple Procedure Payment Reduction (MPPR) for selected therapy services
  • BONUS: A checklist to help you prepare for an audit

Seminar Time:

Seminar Check-In: 8:30 AM  Seminar Program:  9:00AM - 4:00PM



 

Seminar Summary:

Stay up-to-date on outpatient therapy services' guidelines and regulations (see full course description)

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