Physical Therapists: You Could Be Earning More from Medicare

Physical Therapists: You Could Be Earning More from Medicare

Medical Billing is an incredibly confusing topic for healthcare professional and in the last few years, the billing codes have become increasingly complex with the introduction of ICD-10. This increased the number of codes by a whopping 50 000 and has led many to be confused at the process. Whilst you have been getting to grips with the new codes and complexity important court rulings have occurred that could drastically affect your bottom line. Although this ruling came down  almost 4 years ago, CMS is still clarifying the ruling after being accused of not going far enough by some


Jimmo vs Sebelius | Medical BillingJimmo vs Sebelius

This case argued that regulators had been unfairly not allowing certain types of physical therapy – specifically maintenance therapy whereby patients have little to no chance of recovery. This had been going on for years and had meant the therapy was not given out by therapists as it could not be billed under Medicare. However, CMS clearly states ‘coverage of skilled nursing  and skilled therapy services in the Skilled Nursing Facility  (SNF), Home Health (HH), and Outpatient Therapy (OPT)  settings do not turn on the presence or absence of a  beneficiary’s potential for improvement, but rather on the
beneficiary’s need for skilled care.”


Experts say not enough has been done


Then a number of years after the court ruling District Court Chief Judge Christina Reiss wrote that CMS had not gone far enough to educate people on the ruling and that they could include this as part of Medicare physical therapy billing. The Senior Vice President of Finance Policy and Legal Affairs at the American Healthcare Association said in an interview to McKnights


“[CMS education effort] has not been adequate, timely or complete”


LeadingAge Senior Vice president Cheryl Phillips also talked to McKnights Long Term Care News noting


“[the news reflects] significant confusion for providers and patients regarding when skilled services are needed, not for improvement, but for maintenance in chronic conditions”


In rebuttal to this, a web page outlining the settlement and what it means for claiming on medicare has been set up recently by CMS. You can find the link to it here.


The confusing world of physical therapy billing

This ruling is one example of the tricks that can catch even the best therapists out. Having to learn your discipline and rise to the demands of treating patients is difficult enough in itself without the endless web of confusing stories about updates to the ICD or court rulings. Physical therapy billing can be simplified using a number of specialist service providers. By outsourcing the billing to a specialist, you get to focus on what matters most, the patients. In addition to this, it can often save you or even make you money as these experts work day in day out in the industry and know every thread of every tangled web. Unfortunately for many busy practitioners it just isn’t possible to follow developments like Jimmo vs Sebelius as closely as they would like.

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