Hum with me, Big Bird, Grover, Cookie Monster, and the cast of Sesame Street in the Alphabet Song. Are you humming? A B C D E F G ............. Ok, stop there! what "G" you have to say? One of the 42 functional limitation G code reports for PT and OT? Or maybe one of the quality codes G PQRS reports? Oh, I see, you think without electrical stimulation monitoring G. code Wait maybe you thought GP, GO and GN - but stop, it is not technically G- codes, but rather modifiers. Do you have Medicare Confusion G Code? Maybe you thought you had understood then if someone in your clinic asked. Or better yet, a rejected request and received when you called the customer service line to your Medicare contractor they told you that you had a G-code problem. They just explain (they read from scripts call) or you said that he had something to do with PT, OT or SLP provider. Oh ... ..
Medicare Code Confusion G
Let's start with the easy stuff and progress on site by the Medicare G code confusion:
- G II HCPCS codes as Level: G0283 - the HCPCS code used by Medicare (CPT 97014) for electrical stimulation unattended. There are other G codes, including those therapists probably use (many in a CORF), but this is one of the 5 best therapy codes billed according to the CMS statistics as reported in billing reports Physical comparative Therapy by backup services. This code has been around for a while, and most therapists are familiar with its use for health insurance claims
- G Codes for PQRS :. Most codes used by therapists in private practice in reports to the Reporting System physician quality are G. codes These codes are used to report a status of a quality initiative (triggered most often in the therapy of 'an evaluation). There are individual actions and group actions and claims-based reports and journal reports. Most private practices probably use claims-based reports PQRS (it's FREE!), And some may be using registry reports ($$) via an EMR or addition to an independent register. However, these codes because they are justified complaints often cause problems if not properly sequenced on CMS1500 demand, particularly on the day of the evaluation of the therapy when the functional limitation of the G report codes (I myself -even confusing!), and can result in claim denial. Sometimes this is the result of an arbitration problem with your MAC Medicare. PQRS has been around since 07, so for those who participate, even if the quality measures may change from year to year, it is mainly used "G codes".
- Codes G Functional Limitation reports : interesting late arrival and therapy in 2013, with an implementation date of July 1. Compliance 2013, they are fraught with problems . The underlying basis of a loose approach, not standardized to try to assess the functional limitation of the recipient (only 1, not 2, not 3, not ......) and "guess" their results, and report on the process every 10 visits pairs codes. There are several exceptions, and CMS is still setting a full 12 months after the start of the "trial period" on 1/1/2013. But these are the G codes that were on the verge failover claims problems. WPS recent report on the problems of complaints on the part A side (hospitals, rehabilitation agencies, and CORFs FRR) and taking operator error (read that to be error or therapist, billing errors) out of mixture, there CMS changes "hard" on request arbitration and contractor publishes "soft". Therapists are coming with multiple scenarios of patients that CMS ever expected, and find applications rejected due to arbitration proceedings, which include receivables order sequencing. We'll do another post on this whole mess
Medicare Confusion G Code -. More Confusion with Modifiers
Ok, now add a new wrinkle in the Medicare G code confusion, here are the G modifiers, not to be confused with the G codes When the therapy caps were mandated by the law on fiscal balance of 1997, CMS required all disciplines to enter a modifier indicating the type of therapy GP, GN GO or modifier. In this way, on a claim, CMS could distinguish which course therapy to affect the fees charged (either to the PT / OT cap SLP or cap). Who worked on the CMS 1500 claims but the claims UBo4 for institutional providers, therapy modifier must also match the appropriate revenue codes series: 42x for PT, OT and 43X to 44X for SLP. Here is the discipline of therapy modifiers that should be on every request line (including functional disability reports:
- Physical Therapist - signified by GP
- Occupational Therapist - served by GO
- speech therapist - signified by GN (GN ??)
Clearing Up Confusion Medicare code G - Reading the book
what is a supplier to more importantly what is everyone who is involved in this process do? prohibition of terminology "G code," call all by name, PQRS, FLR, electrical stimulation without supervision and therapy modifiers discipline . do this to communicate with your billers, people who pay admission, and especially those who will call your Medicare contractor to ask why an application was rejected. Believe me, if you do not have your "code G "(oops, I thought I just banned that!) playbook rectified by the time you have finished talking to your service to the MAC client, you will not be sure!
What problems have you had complaints and FLR, PQRS in particular? Do you have any questions? Does your Mac told you to go back and read MM8005? Have you read MM8005 a million times and nothing in it answers to your problems? Let me know ......
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Nancy Beckley
Nancy J. Beckley is the president of Nancy Beckley & Associates LLC, a firm specializing in compliance with outpatient therapy. The firm offers outsourcing the compliance risk assessment, compliance plan development, annual compliance training, and external audit, due diligence and investigative support. Customers are suppliers under Medicare review of the probe, the plans of progressive corrective actions, corporate integrity agreements, ZPIC investigations and RAC audits.
Nancy background includes 15 hospital years experience in the service management capabilities to two large rehabilitation facilities for inpatients with extensive managed care contracting and program management expertise. A therapist in the background and training, Nancy served as program director, director of the institution and administrator in both rehabilitation facilities for inpatients and outpatients.
She is a nationally recognized speaker in the field of rehabilitation of compliance, and presented to the Conference Provider Practice Compliance, Florida Compliance Conference, and the Healthcare Compliance Compliance Institute Association. It was described in a Healthcare Compliance Association webinar on the risk of hospitalization in outpatient therapy, and wrote three articles for compliance Today and written over 20 articles on the RAC program.
Mrs. Beckley area of expertise includes:.
• Development of the compliance program, consulting, training, and the external auditor
• Medicare Regulatory requirements for suppliers outpatient therapy, including extensive experience in the investigation and Medicare certification for outpatient treatment providers
• auditing and consulting commitments under attorney-client privilege for risk assessment and the analyzes the potential recovery of responsibility
• Medicare program integrity initiatives: MACs, RACs, CERTs, ZPIC, critics of the probe before and after payment of examinations
• recognized expert national level on CORFs, served on the technical expert Group Medicare CORF
• outpatient Hospital board compliance, audit and training
• compliance diligence activities due in the acquisition and portfolio development to assess compliance risk Medicare
EDUCATION: University of South Florida, MBA; Harvard School of Public Health course for managed care executives; University of Illinois, m.s. University of Wisconsin, B. s
PROFESSIONAL ASSOCIATIONS: Board of Directors, National Association of Rehabilitation Agencies (NARA) Members, Healthcare Compliance Association; Contributing Editor principal RAC Monitor + monitor Monday; Compliance columnist for IMPACT Journal of APTA
PROFESSIONALCERTIFICATIONS: CHC, certified Health compliance by the Healthcare Compliance Certification Board
PUBLICATIONS AND PRESENTATIONS: Available on request
CONTACT: 414-748 -4376; Nancy@NancyBeckley.com;
Latest posts of Nancy Beckley (see all )
- Call Medicare Denials - 5 things you need to know - June 18, 2014
- therapy PQRS Panic - June 5, 2014
- Medicare Confusion G code - May 28, 2014
- Medicaid exclusion controls - May 7, 2014
- Checking Importance Exclusions - April 30, 2014
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