Occupational therapists provide care in relation to timed therapeutic procedures and untimed modality-based therapy. Occupational Therapy Medical Billing requires these categories to be maintained separately and coding medical procedures in each category would also be done in a different manner. If any of these types of revenues are treated as filing the same way with CCV, no one is going to be aware of these obvious rejections; the revenues will simply be lost.

Timed Codes and the 8-Minute Rule in Occupational Therapy Medical Billing

One of the most widely misunderstood rules in occupational therapy medical billing, is the 8-minute rule that is used to bill Medicare for timed procedure codes. It is not uncommon for therapists and billing staff to underbill due to a lack of understanding with regards to how to count units for total timed service minutes. First, all timed minutes for each session be gathered together and then assigned to the units based on the Medicare conversion table. 

Untimed Codes and What They Actually Mean

Untimed treatments such as electrical stimulation, hot and cold pack and ultrasound are charged as a single code per minute of time. Occupational therapy medical billing separate teams both over code and inflate the number of code units. Not documenting minutes while timed to be reimbursed as untimed or incorrectly documenting minutes as untimed underestimate the number of units, and possibly result in remaining units not being earned.

KX Modifier and Therapy Cap Compliance in Occupational Therapy Medical Billing

The KX modifier is used on every therapy claim higher than the therapy threshold for the calendar year in Medicare's limits. In Medicare, the annual therapy threshold is applied to all therapy claims that are less than the therapy threshold amount in the calendar year, and so the KX modifier must be used on these claims. The medical billing for occupational therapy should record and show the total amount of occupational therapy spent per beneficiary and the KX modifier when it is exceeded. Any claim passed in above the limit without the KX modifier is denied automatically; services that are fully covered will need the manual KX modifier. This is an error that accumulates as it is a systematic error, without anyone actively monitoring the accumulation of spending per patient.

Why Outsource Medical Coding Services Instead of Managing It In-House

Medical Coding is an ever-evolving field. CPT codes are updated and new ones are added each January. The ICD-10-CM codes will be released once a year, in October. Coverage policies and coding guidelines are issued all year round by payers. To outsource, or delegate, the Outsource Medical Coding Services to a specialist group is to have someone on your team who is actively making sure to update the services' coding and stays in tune with the new codes, standards and rules. It's difficult for in-house teams to keep up because they're extremely busy with volume, and external teams are cutting edge.

CPT and ICD-10 Updates and What Happens When They Are Missed

After the new codes have replaced the deleted ones the old codes, including CPT and ICD-10 codes, are automatically rejected in practices that continue to use them. It cannot occur when you have out-sourced medical coding services and the medical coding process includes the job of updating. A specialist coding team does not receive knowledge of the changes to their code in denial reports. They have all been informed about them prior to any such regulations coming into effect and they have already updated their procedures and systems accordingly.

Specialty-Specific Coding Knowledge That Generalists Do Not Have

Choosing a practice that outsources medical coding services to one of a generalist team will have individuals who are familiar with common medical coding. When they work with experts, they obtain individuals who know some of the subtleties of their particular field of expertise. Many coding conventions and payer policies exist for each surgical specialty, behavioral health, radiology, and emergency medicine; these won't be completely covered during the education of standard coding. The difference between a coding team that processes claim versus one that does code with special expertise is based on the breadth of specialty expertise.

Compliance Oversight Built into Outsourced Medical Coding Services

If you are selecting the highest E&M level every time, that won't match expectations and may cause a player to follow the case through and lead to an audit. By outsourcing medical coding services to a good partner, you get a private survey of the coding processes and can be warned if you're coding things that have a probability of being unusually far-fetched or out. The review process of outsourcing medical coding services to a quality partner will keep an eye on the coding patterns and catch the things that look statistically unusual before an outsider ever does.