Physical therapy billing question

edited June 2017 in Part B Archive

I was contacted by a potential client and need some help understanding an
aspect of physical therapy billing.



The group is made up of physical therapists only (allowed in the state they
do business).



In review of several EOB's with redacted patient information, I noticed the
group is paid under their organization NPI under Medicare Part B, but each
line item does not show the physical therapist's individual NPI, it is
blank.



Besides therapy caps, modifiers, and what-not - what is unique about PT
billing that would allow the claim to pay under Part B (which means a CMS
1500 submission) without identifying the individual provider's NPI?



Thanks so much,





Karen A. Hurley, BS, CMM, CPC, CNA

President, HPMSI

PO Box 409

Parrish, FL 34219-0409

Tel: (941) 776-4822

Fax: (240) 368-0059

Web: www.hpmsi.com



Since 1996, Celebrating 20 years of Service to Physicians



Disclaimer: Advice or comments in this email are specific only to the
recipient and the presented issue. It is not intended to be used as a
global solution for future similar events. Reproduction of the information
requires approval by the author.




Comments

  • It's possible they're billing as a CORF...Comprehensive Outpatient Rehabilitation Facility. Ask, they should know if they've been certified and enrolled in one.

    Here's some information from CMS: https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/CertificationandComplianc/CORFs.html

    Kris

    Kris Cuddy, CPC, CIMC
    Healthcare Compliance Analyst
    Compliance Office
    Michigan State University HealthTeam
    East Lansing, MI
    Ofc: 517-355-4547
    Fax: 517-353-5292

  • edited June 2017

    Yes, I did ask that and no, they are not.



    The previous link I put up explained the problem I was having, the 'Easy
    Print' option to produce a Medicare EOB does not place the rendering
    provider NPI in the column all the way to the left.



    When auditing - I use the EOB, the charge slip (or entry process), and the
    documentation.



    Unfortunately with Easy Print, you can't tell which provider submitted the
    claim - you can only see the group NPI at the top right.



    Strange for me as I don't use Easy Print - I've used paper EOB's in years
    past and the auto-transmittal directly from Medicare.



    Thanks, Kristine !



    Karen A. Hurley, BS, CMM, CPC, CNA

    President, HPMSI

    PO Box 409

    Parrish, FL 34219-0409

    Tel: (941) 776-4822

    Fax: (240) 368-0059

    Web: www.hpmsi.com



    Since 1996, Celebrating 20 years of Service to Physicians



    Disclaimer: Advice or comments in this email are specific only to the
    recipient and the presented issue. It is not intended to be used as a
    global solution for future similar events. Reproduction of the information
    requires approval by the author.



  • Wow, that's very interesting Karen. Thanks for the update!

    Kris

    Kris Cuddy, CPC, CIMC
    Healthcare Compliance Analyst
    Compliance Office
    Michigan State University HealthTeam
    East Lansing, MI
    Ofc: 517-355-4547
    Fax: 517-353-5292

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