‘Tis the season for a lot of things merry, but appeal and denials are not so cheery. Requests from Medicare Administrative Contractors (MAC) in the Skilled Nursing Facility (SNF) and Medicare Part B outpatient clinics are on the rise. Time is of the essence when a facility receives communication from a MAC; however, some requests are more impactful than others. Let’s review the various types of appeals and the focus areas. The Centers for Medicare…
Have you ever heard the term “improbable” day as it relates to coding and billing direct, one-on-one CPT Codes in Healthcare? You might be more familiar with the term “impossible day.” They both imply an improbable scenario of coding and billing volume in a given claim date based upon data analysis of payor paid claims. Based upon CPT Code definitions, attendance requirements, and clinician availability on a given claim date data analysis can flag providers…
The recent self-disclosed conduct to the Office of the Inspector General (OIG) by Team Rehabilitation Services (TRS) is a reminder of the importance of proper coding by physical and occupational therapists. TRS agreed to pay over $12MILLION for allegedly violating the Civil Monetary Penalties Law. There were issues identified with improper billing for time-based codes and for the specific CPT code of 97164, the re-evaluation code. When coding time-based codes for Federal payors, or those…
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