HCPro.com: Briefings on Outpatient Rehab: Reimbursement and Regulations

Ever-changing reimbursement policies and government regulations affects your facility's ability to stay in compliance. Briefings on Outpatient Rehab Reimbursement & Regulations reports on these changes and offers suggestions on how best to cope with them.

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May 2008 (Volume 12, Issue 5)	view entire issue

Revised ABN should cause less confusion for patients
On March 3, CMS released the new Advance Beneficiary Notice (ABN) of Noncoverage (ABN-R-131). This form will be used for all Part B provider and supplier services, making it essential for all rehab providers to be aware of the change-except for those in skilled nursing facilities (SNF), as CMS is revising the ABN form for SNFs and will release it later this year.

Choosing the correct ICD-9 code poses problems for therapists
Because CPT codes lead directly to reimbursement, therapists spend much more time discussing them compared to the time spent on ICD-9 codes. However, without selecting the correct ICD-9 code to diagnose why you are treating the patient, you're increasing your odds of having the services denied by the payer. "ICD-9 codes are a problem for therapists because they are usually not an area of focus in the initial training to become therapists," says Kate Brewer, PT, MBA, GCS, president and owner of Progressive Rehab Solutions and vice president of the Greenfield (WI) Rehabilitation Agency. "It is something that is learned from an employer, or sometimes is handed off to a back office coding or billing specialist."

Out-of-network practice does not mean cash-based
As insurance companies continue to reduce their reimbursement rate-which makes running a financially successful therapy facility more difficult-the thought of a cash-based practice becomes more appealing, says Barry Inglett, PT, CHT, Cert. MDT, owner of Wayne (NJ) Physical Therapy & Spine Center and Mailly & Inglett Consulting, LLC. But many therapists miss out on the important distinction between being cash-based and out-of-network, Inglett says.

New rule bans the use of stamped signatures
CMS may have unintentionally made life much more difficult for therapists when the agency decided to restrict the use of stamped signatures. In Transmittal 248, Change Request 5971, released March 28, CMS states, "Medicare requires a legible iden-tifier for services provided/ordered. The method used shall be hand written or an electronic signature (stamp signatures are not acceptable) to sign an order or other medical record documentation for medical review purposes."

Beware of hidden clauses in managed care contracts
It's difficult enough dealing with managed care contracts that are reducing fees and making it difficult to be a therapist. But when those same managed care companies start putting questionable language into contracts that could trigger a reduction in reimbursement for certain services, rehab providers must begin taking more caution then ever before in examining contracts. The problem stems from the general contracts that managed care companies and preferred provider organizations (PPO) are pushing on rehab providers to sign, with clauses sometimes called silent PPOs.

Other recently-published articles from Briefings on Outpatient Rehab: Reimbursement and Regulations:

Medicare changes give more SLPs option to go private in 2009

Manage your facility’s front office well for good first impressions and a successful practice

Don’t let backend operations be your facility’s downfall

BRRR coding corner

BRRR Q&A

Delegating tasks and billing appropriately

BRRR coding corner

Make your electronic records comply with HIPAA standards

Treating autism: More states require insurance coverage

PQRI update: The 2007 bonuses have arrived

BRRR coding corner

Fitness and wellness programs: Make your practice more fiscally fit

Going digital: Implementing electronic records in your practice

Congress delays full implementation of therapy caps

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