Training Course
Syllabus:
PROGRAM DETAILS
Insurance payers are increasingly reviewing therapy claims to ensure that the
therapy provided to the beneficiary required the skills of a therapist, was
billed appropriately and the required documentation was present in the patient's
medical record. The Centers for Medicare and Medicaid Services continue to focus
their efforts on reducing inappropriate payments to providers of therapy
services in all settings as outlined in the Office of the Inspector General's
2007 workplan.
Outpatient Therapy CPT Coding, Billing and Documentation for Rehabilitation
Reimbursement covers the correct use of CPT codes, G, and L Level II codes, and
modifiers used by Physical, Occupational and Speech Therapists in all outpatient
settings including private practice, hospital-based, rehab agencies,
comprehensive outpatient rehabilitation facilities, skilled nursing facilities
and in a patient's home. The course also covers ICD-9-CM coding guidelines as
they pertain to outpatient therapy services. Billing scenarios are discussed and
reviewed to ensure therapists can accurately charge patients correctly for their
services. This course also examines the most common reasons claims are denied
for all payers and thoroughly reviews Medicare Part B and other third party
payer documentation guidelines for initial evaluations, re-evaluations, progress
reports, daily notes, certifications/recertifications, plan of treatment and
physician orders. Resources and references are provided to assist therapists to
stay current with the ever-changing reimbursement guidelines and regulations as
they pertain to outpatient therapy services.
WHAT YOU WILL LEARN
- Learn and understand use of CPT, G, and L codes
- Charge correctly for the services you provide
- Understand the Medicare Automatic and Manual Process Exceptions
- Identify and avoid the main reasons for denials
- Master all the necessary components of documentation
- Define service-based vs. time-based CPT codes
- Describe the rationale for the use of CPT, G, and L codes in all
outpatient settings
- Define and distinguish between mutually exclusive edicts and column
1/column 2 edits
- Be able to read the CCI edit chart and appropriately append modifier -59
to the correct CPT code(s)
- Be able to document appropriately to support the treatments provided and
the use of modifier -59
- Learn and understand the ICD-9-CM coding guidelines as they pertain to
outpatient therapy services
- Understand how ICD-9 codes support medical necessity by the various
insurance payers
- Be able to charge correctly for the services you provide under outpatient
therapy benefits
- Identify the most common reasons for denials of outpatient therapy
services by all providers
- Delineate the specific requirements for physician orders for outpatient
therapy services
- Identify reasonable and necessary criteria for skilled therapy services
- Describe and implement the necessary components of documentation to
support skilled therapy services for reimbursement
- Be able to write function-based short- and long-term goals based on the
patient's functional deficits
- Provide the definitions and requirements for developing plan of care and
the certification/recertification process
ABOUT THE SPEAKER
Rick Gawenda, PT, graduated in 1991 with a Bachelor of
Science in Physical Therapy from Wayne State University, Detroit, Michigan. Mr.
Gawenda is currently Director of Physical Medicine and Rehabilitation at Detroit
Receiving Hospital overseeing all PM&R services provided in both the inpatient
and outpatient setting and owner of Gawenda Seminars.
Mr. Gawenda is on the editorial advisory boards for Advance for Directors in
Rehabilitation and Briefings on Outpatient Rehab Reimbursement and Regulations.
Mr. Gawenda is the consulting editor for Outpatient Physical Therapy Coding
Alert and Eli's Rehab Report. Mr. Gawenda is a member of the
American Physical Therapy Association (APTA), Michigan Physical Therapy
Association (MPTA), MPTA Insurance Relations Committee, MPTA Director #1
overseeing the Legislative and Bylaws Committees, and President of the Section
on Health Policy & Administration of the APTA. Mr. Gawenda serves as the liaison
between the MPTA and United Government Services, who is the Medicare Fiscal
Intermediary for the State of Michigan.
Mr. Gawenda has provided his expertise for many articles in Briefings on
Outpatient Rehab Reimbursement and Regulations and Eli's Rehab Report,
on various topics such as Advance Beneficiary Notice, Medicare
certification/recertification, utilization of "L" codes as they relate to
therapy, reimbursement and documentation, and the use of aides in therapy. In
addition, Mr. Gawenda has written articles for Advance for Directors in
Rehabilitation on CPT coding, Modifier 59, The Medicare Appeals Process,
and has a monthly Q&A column where he answers questions submitted by the
readers. Mr. Gawenda is also the author of The How-To Manual for Rehab
Documentation: A Complete Guide to Increasing Reimbursement and Reducing Denials
as well as Coding and Billing for Outpatient Rehab Made Easy: Proper Use of
CPT codes, ICD-9 codes, and Modifiers.
TESTIMONIALS
"Very impressed with the presenter's knowledge of this topic." -
Glen McBride, SLP-CCC, Kansas City, Missouri
WHO SHOULD ATTEND
- Physical Therapists
- Occupational Therapists
- Speech Language Pathologists
- Physical Therapy Assistants
- Certified Occupational Therapy Assistants
- Rehab Directors, Managers and Supervisors
- Rehab Billers and Coders
- Physicians
- Nursing Home Administrators
CREDITS
Cross Country Education is a Preferred Provider of professional continuing
education with the National Association of Boards of Examiners of Long Term Care
Administrators (NAB) and has approved this program for the number of clock hours
listed under their sponsor agreement with NAB/NCERS. This program is approved
for 6 continuing education clock hours Approval #2822007-24144-6. State
licensure boards, however, have final authority on the acceptance of individual
courses.
This program has prior approval by the American Academy of Professional Coders
for 6.0 Continuing Education Units (Index #CCE0613070352A). Granting of prior
approval in no way constitutes endorsement by AAPC of the program content nor
the program sponsor. Full attendance is required to receive credit for Coders;
variable credit for partial attendance may not be awarded based on the AAPC
guidelines.
Cross Country Education is approved by the Continuing Education Board of the
American Speech-Language-Hearing Association (ASHA) to provide continuing
education activities in speech-language pathology and audiology. This program is
offered for .6 CEUs Introductory level; Related area. ASHA CE Provider approval
does not imply endorsement of course content, specific products, or clinical
procedures.
Cross Country Education is an approved provider of continuing nursing education
by the Tennessee Nurses Association, an accredited approver by the American
Nurses Credentialing Center's Commission on Accreditation. Provider #044013109,
this course is offered for 6.0 contact hours.
Cross Country Education is an approved provider with the Iowa Board Of Nursing,
approved provider #328. This course is offered for 7.2 contact hours.
Cross Country Education is an approved provider by the Florida Board of Nursing,
provider #50-466. This course is offered for 7.2 contact hours.
Cross Country Education is approved by the California Board of Registered
Nursing, Provider #CEP 13345, for 7.2 contact hours.
Cross Country Education is an AOTA Approved Provider of continuing education.
This course is offered for .6 AOTA CEUs. The assignment of AOTA CEUs does not
imply endorsement of specific course content, products, or clinical procedures
by AOTA. AOTA Educational level Intermediate, Category 3: Professional Issues
This program has been approved for 6 CEUs by the Ohio Physical Therapy
Association for Physical Therapists and Physical Therapy Assistants (Approval
#07S1110).
This seminar qualifies for 6 continuing education hours as required by many
national, state and local licensing boards and professional organizations. Save
your course outline and certificate of completion, and contact your own board or
organization for specific filing requirements.
SEMINAR CLASS TIME
Seminar Check-In: 7:30 AM Seminar Class 8:00 AM - 3:30 PM |
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