This lesson explains the basics of the documentation and billing requirements for outpatient therapy (OPT) services that deal with physical therapy (PT), occupational therapy (OT), and speech-language pathology (SLP) that are provided under Medicare Part B. Documentation, coding, and billing requirements are covered. This lesson may feature information on the use of medical and procedural codes, including CPT codes as they relate to the subject matter presented.
“This program has been approved for 0.5000 continuing education unit(s) for use in fulfilling the continuing education requirements of the American Health Information Management Association (AHIMA). Granting prior approval from AHIMA does not constitute endorsement of the program content or its program sponsor.”
This activity is approved for 0.5000 contact hours.
“This program has been approved for 0.5000 continuing education unit(s) for use in fulfilling the continuing education requirements of the American Health Information Management Association (AHIMA). Granting prior approval from AHIMA does not constitute endorsement of the program content or its program sponsor.”
Outline:
Section 1: Introduction
About This Course
Learning Objectives
Coverage Policies
Provider Definitions
Review
Section 2: Certification
Conditions of Coverage Certification
Orders/Referrals and Need for Care
Review
Plan of Care
Sample Therapies
Revision of Goals
Section 3: Payment and Reporting
Payment Caps and Medical Necessity
Modifiers
Review
Section 4: Time
Untimed Codes and Units of Service
Clarification of Time
Review
Section 5: Conclusion
Course Summary
Course Contributors
Resources
Bibliography
References
Expert Reviewer: Jean C. Russell, MS, RHITDeborah is responsible for Elsevier's online solution of education and tools to improve employee performance for Revenue Cycle, Coding, CDI, and Compliance professionals. Deborah has earned BS degrees in Management/Human Resources and Social Psychology. She is a Registered Health Information Management Administrator (RHIA) and is a Certified Coding Specialist, Physician-Based (CCS-P). Prior to joining Elsevier, Deborah held positions such as Revenue Cycle Analyst for Mayo Clinic; Compliance Officer; educator; coding manager; and senior consultant. Deborah actively participates on projects important to the healthcare industry. As an active member of AHIMA, she has participated in the Quality Initiatives & Secondary Data Practice Council, was Chair of the Coding Policy and Strategy Committee and Board member for the Society of Clinical Coding. She has authored journal articles, been a presenter of audio-conferences and a speaker at national and state conventions. Deb was a member of the AHA Editorial Advisory Board for ICD-9-CM Coding Clinic and AHA Editorial Advisory Board for HCPCS.
Disclosure: Deborah Neville, RHIA, CCS-P has declared that no conflict of interest, Relevant Financial Relationship or Relevant Non-Financial Relationship exists.
Expert Reviewer: Veronica Ziac, MBAJean Russell has over thirty years of healthcare and information system experience. Her areas of expertise include the Medicare outpatient prospective payment systems (APCs, and APGs), as well as ICD-10-CM/PCS training, Charge Description Master (CDM), admission status reviews, and outpatient coding and compliance. She is a frequent speaker at the national, state and local levels for HFMA and AHIMA professional groups. Jean has her Masters from the University of Houston in Biomedical Engineering; her Bachelors from Colgate University in Biology; and her RHIT from the independent study program through the American Health Information Management Association.
Disclosure: Jean C. Russell, MS, RHIT has declared that no conflict of interest, Relevant Financial Relationship or Relevant Non-Financial Relationship exists.
Veronica Ziac, MBA has over twenty years of healthcare administration experience. Her areas of expertise include revenue cycle, information systems, population health and physician practice management. Most recently, she was the Director of Revenue Cycle Integrity at Cobleskill Regional Hospital. Prior to that, Veronica was the Chief Operating Officer for a large multispecialty hospital-based physician practice based in New York. Veronica has an MBA in Healthcare Administration from Union College and a bachelor’s degree from the University at Albany. She is a member of HFMA and MGMA and has been Certified in Healthcare Compliance (CHC) by the Healthcare Compliance Association.
Disclosure: Veronica Ziac, MBA has declared that no conflict of interest, Relevant Financial Relationship or Relevant Non-Financial Relationship exists.
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