day nine: billing stuff Flashcards
three areas that determine overall complexity:
occupational profile
deficits in performance areas
amount of clinical reasoning involved
what insurance requires total time governing how many units you can bill?
Medicare
how does Medicare keep track of units
report what was done in minutes and units. the units are determined based on the total time in therapy
8 minute rule
you round up or down dependent on the eight minutes
Medicare will reimburse the intervention that
required the most skill or where more time was devoted
timed codes:
timed codes are billed using Medicare’s 8 minute rule.
unlimited codes:
codes billed one unit per date of service regardless of the number of anatomical body areas treated to time spent.
what codes do we currently use for outpatient?
CPT
what series are CPT codes for outpatient reported in
9000 series
Part A is
skilled nursing facilities PPS
Part B is
Outpatient PPS
OASIS is used for
Home health PPS
inpatient acute hospital payment is based on
diagnosis
CMC
center for medicare and Medicaid services
MAC:
medicare administrative contractor
CPT:
common procedural terminology
HCPC:
Health Care Common Procedural Coding System
PPS:
Prospective Payment Systems
new codes promote OT and a
distinct value
CPT identifies four components of a the evaluation process:
- occupational profile
- assessment of op
- clinical decision making
- development of plan of care
the therapist determines _______ in the evaluation process:
how complex or broad the occupational therapy profile and medical nd therapy history must be
low complexity:
brief problems focused
moderate complexity
expanded
- review of history related ot presenting problems
high complexity
extensive additional review of history
