BHS Blog / Healthcare News and Trends

How to Bill Medicare and Medicaid for Physical Therapists

Posted on: February 2nd, 2021

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In my blog for January, we took a look at an article on lexology.com, detailing how the Department of Health and Human Services and The Department of Justice have started enforcement on Physical Therapy Providers that bill Medicare and Medicaid. In my blog this month, I wanted to explore ways to address the authors’ key takeaways for physical therapists and clinic owners everywhere.

What were the key takeaways from the original article, and how can physical therapists best position themselves when the Department of Justice (DOJ) and The Department of Human and Health Services (HHS) are taking notice? Read on for some key points and how to ensure that your medicare and medicaid billing is air-tight.

Takeaway #1: Accurate Reporting

“Accurately report the duration of services provided. For example, allegations of fraudulent billing arose when an audit revealed four simultaneous, hour-long, one-on-one appointments that were scheduled within the same time frame.”

To accurately report the duration of services provided:

  • Ensure the documentation includes the time in and time out for each patient,
  • Bill services that that are “one-on-one” and/or,
  • Utilize group coding when patients are treated concurrently.

For Example:

Patient A is treated for 40 minutes from 10 a.m. to 10:40 a.m. and patient B for 40 minutes from 10:20 a.m. to 11:00 a.m.

Patient A arrives at 10 a.m., the PT provides eight minutes of manual therapy and 12 minutes of balance training (neuromuscular reeducation), and finishes with 20 minutes of therapeutic exercise for a total of 40 minutes.

Patient B arrives at 10:20 a.m. and begins with 20 minutes of therapeutic exercises performed simultaneously with patient A.

Both patient A and B are billed for Group Therapy between 10:20 a.m. to 10:40 a.m.

Patient A leaves the clinic at 10:40 a.m. while patient B continues with 10 minutes of therapeutic activities and 10 minutes of manual therapy.

In this example, patient A is billed one unit of neuromuscular reeducation, one unit manual therapy, one unit of group therapy and patient B is billed one unit of therapeutic activities, one unit of manual therapy, and one until of group therapy.

Takeaway #2: Avoid Fraud Claims

“Healthcare fraud claims due to “rounding up” appointment times to maximize reimbursement, providing unnecessary services to increase the time, or engaged patients in unskilled exercises not in line with plan-of-care goals in order to obtain additional minutes. To avoid this, ensure that claims submitted reflect actual PT services provided and that the procedures are supported by the documentation.”

To avoid healthcare fraud clams:

  • Provide services that are medically necessary
  • Ensure all codes billed are supported by the documentation
  • Provide care that is in line with the patient’s impairments and goals

For Example:

Billing codes for therapeutic activities or manual therapy to treat a second body part for which there were no evaluation findings, goals, or impairment codes within the plan or care could be seen an example of engaging patients in unskilled exercises not in line with plan-of-care goals, in order to obtain additional minutes or “rounding up” appointment times to maximize reimbursement.

Takeaway #3: Be Proactive to Prevent Whistleblowers

“The False Claims Act (FCA) provides financial incentive for whistleblowers aka “qui tam relators” to report suspect fraud on their current or former employers. Taking proactive measures that demonstrate that a company takes compliance seriously can diminish qui tam actions.”

To prevent whistleblowers:

Ensure that only licensed Physical Therapists and Physical Therapy aides are providing skilled services, remember unlicensed staff is not allow to bill for services. Be sure to identify billing errors and take action to correct improper documentation or billing practices before causing devastating amounts of liability under the FCA.

Demonstrate to all staff that your company takes compliance seriously:

  • Training all staff how to compliantly schedule, treat, and bill for skilled services
  • Do not wave copays and co-insurance
  • Do not ask support staff to schedule patients non-compliantly
  • Do not allow unskilled staff to provide skilled services to patients
  • Educate staff and incorporate compliance plans and policies,
  • Address concerns related to compliance or billing
  • Conduct internal audits, peer to peer reviews, and exit interviews
  • Take corrective actions

By keeping in mind all of these takeaways, you can avoid taking unnecessary risks when billing Medicare and Medicaid. And if you find that you need more staff in order to maintain compliance? BHS is happy to help!

Just fill out the form to the right to get started!

Allison Stringer, MS, PT, FAAOMPT, CHA
About Allison Stringer, MS, PT, FAAOMPT, CHA

Allison Stringer, Physical Therapist, is the Clinic Director for Professional Physical Therapy in Salem, MA. Allison received her Master’s Degree in Physical Therapy from Simmons College in 1993. In 2000, she achieved the status of a Fellow of the American Academy of Orthopedic Manual Physical Therapists after completed the Institute of Orthopedic Manual Physical Therapy. Allison continues to treat patients and specializes in manual Physical Therapy for patients with orthopedic injuries to the spine and extremities, sports medicine, and wide range of Women’s Health issues including incontinence.