MDS Alert
Work as a Team? Don’t Bill Individually
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Question: A new physical therapy colleague says he can bill the services he provides each resident separately from other members of our team, even though we’re working with the same resident at the same time. Is this true? Virginia Subscriber Answer: No, this is expressly forbidden, according to the RAI Manual. Neither therapists nor therapy assistants can bill separately for the same or different service provided at the same time to the same resident (or patient), the RAI Manual says on page O-21. The RAI Manual provides additional clarification: “CPT® codes are used for billing the services of one therapist or therapy assistant. The therapist cannot bill for his/ her services and those of another therapist or a therapy assistant, when both provide the same or different services, at the same time, to the same patient(s). Where a physical and occupational therapist both provide services to one patient at the same time, only one therapist can bill for the entire service or the PT and OT can divide the service units.” Again, Medicare Part A and Part B have different requirements, according to the RAI Manual: For Part A: “When two clinicians (therapists or therapy assistants), each from a different discipline, treat one resident at the same time with different treatments, both disciplines may code the treatment session in full.” For Part B: “Therapists, or therapy assistants, working together as a ‘team’ to treat one or more patients cannot each bill separately for the same or different service provided at the same time to the same patient.” Additionally, for Part B: “CPT® codes are used for billing the services of one therapist or therapy assistant. The therapist cannot bill for his/her services and those of another therapist or a therapy assistant, when both provide the same or different services, at the same time, to the same patient(s). Where a physical and occupational therapist both provide services to one patient at the same time, only one therapist can bill for the entire service or the PT and OT can divide the service units.”
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Work as a Team? Don’t Bill Individually
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