Eli's Rehab Report
Reader Questions:
Know the Green Lights for Billing an Evaluation
Published on Mon Apr 19, 2010 
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Question:
What does Medicare policy say about us doing a physical therapy evaluation? He's a new patient to us, but had a full evaluation and certification for physical therapy for the same diagnosis at the previous rehab facility. Does Medicare limit us from billing a second evaluation for the same diagnosis?
-- Wisconsin subscriber
Answer:
No, Medicare policy does not limit you from billing a second evaluation for the same diagnosis in this situation. If you look at the definition of evaluation in CMS Pub 102, Chapter 15, Section 220, the Centers for Medicare & Medicaid Services states that an evaluation is warranted when the condition is treated in a new setting or for a new diagnosis. Your example would qualify as a new setting since you are a different provider.Other Articles in this issue of
Eli's Rehab Report
- Business Strategies:
Get Started on the Right Foot With Your Worker's Comp Patients
The first key steps can make the difference between bank and bust for these claims. [...] - IRFs:
Crank Your Team Conference Quality Up a Notch
Updating your team conference documentation template can make all the difference. Having a rough ride [...] - Billing:
Use These Tips To Roll Your Worker's Comp Claims in the Right Direction
Don't treat worker's comp like regular health insurance. Calling the employer of a worker's comp [...] - Clip and Save:
Create a Crystal-Clear Job Description for Your Worker's Comp Cases
Open opportunities for an onsite work evaluation, too. You need your facts in line when [...] - Billing:
Make Time to Target Untimed Codes on Your Part B Therapy Claims
Don't let the RACs bilk you out of this one example of appropriate billing. RACs [...] - Clinical Rehab Roundup:
Crank Up Your Assistive Technology Usage in the Schools
Effect of assistive technology in a public school setting. Watson AH, Ito M, Smith RO, [...] - Reader Questions:
Keep an Eye on the OT-SLP Crossover Zone
Question: I have a speech-language pathologist who wants to bill for the following CPT codes: [...] - Reader Questions:
Know the Green Lights for Billing an Evaluation
Question: I work in a private practice setting, and we just acquired a patient who [...] - News Briefs:
New Health Care Legislation Keeps Exceptions Hope Afloat
Got your sights on March 31 as your therapy cap exceptions expiration date? The monumental [...] - News Briefs:
RACs Get a Booster Shot From the White House
If Medicare's Recovery Audit Contractors (RACs) are raking you over the coals, get ready for [...] - News Briefs:
MedPAC Puts In-Office Ancillary Exception Under the Microscope
Expect head-butting between therapists who work for physicians and therapists against physician-owned therapy services. The [...]
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