Plan N-No $20 Copay on Physical Therapy

1. You are way too deep into this. You have no control over procedure/diagnosis codes used at a PT office

2. Technically, there IS coins/copay for PT visits. Unless you use certain codes. Telling a PT to use different codes to avoid the charges sounds like Medicare fraud to me.

3. If you purchase/sell N, you have a copay. N is a great plan. Except when you need extended therapy.


When I had people undergoing physical therapy, I called underwriting at the carrier to get the specific billing codes that could be used that would not generate co-insurance for the client. Once we were able to tell billing how to code it so that insurance would pick it up, everything was fine.

My advice - work with the specific carrier and then you can relay the proper information directly to the billing office associated with the provider.
 
Ok, this is getting interesting.

Example 1: My mother recently had her hip replaced. (She's on G). The home health people tried to tell her that she was going to owe $12.60 for every PT visit. (That went really well for them). But the nurse visits were free. They "made a mistake" and thought she was on N.

Example 2: One of my groups is a physical therapists office. I asked them what that do for people on Medicare. (They don't take Advantage plans). Their billing person told me she loves F&G, but that N drove her nuts, because there is a different charge for every visit. I asked if it was ever free and the answer was "very rarely". (This answer is what drove my mother to G.)

Throwing this out there, because this may be part of the problem. In Texas, you cannot see a PT without docs orders. We have a bill in front of the legislature to change that right now. No clue if that plays into billing or not.

My two cents



1. Home health PT is paid 100% by medicare


2. Like Mason said PT billing dept. is mistaken and are suggesting their customers buy policy that in their mind is easiest for the provider.Unless a doctor is present or on call the OP PT can't bill for a doctor consultation.Medicare pays 80% and all the med supps A-G pay the 20% for OP PT
 
1. Home health PT is paid 100% by medicare


2. Like Mason said PT billing dept. is mistaken and are suggesting their customers buy policy that in their mind is easiest for the provider.Unless a doctor is present or on call the OP PT can't bill for a doctor consultation.Medicare pays 80% and all the med supps A-G pay the 20% for OP PT

I'm really finding this interesting. Seriously.

The Home Health Care company were idiots. Long story, but threats were made after they made my mother cry. What they did was irrelevant. They probably bill everyone and people pay them. (Except my clients. They know if they get a bill to call me. :) )

But the PT Office is different. It wasn't a carrier issue. It was me asking someone I've known for years, who has been doing PT billing for years, what she sees from Medicare on F/G/N. And she said N usually produces a bill.

I'm wondering if its a Texas issue, because all PT requires a doc prescription. Thoughts?
 
I'm really finding this interesting. Seriously. The Home Health Care company were idiots. Long story, but threats were made after they made my mother cry. What they did was irrelevant. They probably bill everyone and people pay them. (Except my clients. They know if they get a bill to call me. :) ) But the PT Office is different. It wasn't a carrier issue. It was me asking someone I've known for years, who has been doing PT billing for years, what she sees from Medicare on F/G/N. And she said N usually produces a bill. I'm wondering if its a Texas issue, because all PT requires a doc prescription. Thoughts?
It's never a carrier or state issue. The CPT codes subject to the copay for Plan N are set by Medicare and there are exactly 15 of them. 10 codes for doctor visits (code used determined by new or existing patient, severity of condition, and length of time with the doctor), 4 codes for ophthalmology visits, 1 code for psychotherapy visits. That's it.
 
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It's never a carrier or state issue. The CPT codes subject to the copay for Plan N are set by Medicare and there are exactly 15 of them. 10 codes for doctor visits (code used determined by new or existing patient, severity of condition, and length of time with the doctor), 4 codes for ophthalmology visits, 1 code for psychotherapy visits. That's it.

Agreed it's not a carrier issue, but some carriers can offer guidance on the coding and what the result will be for the client. I've found them to be very helpful when I have specific situations. Some billing people are not as experienced as they should be and have welcomed the guidance, as well.
 
It's never a carrier or state issue. The CPT codes subject to the copay for Plan N are set by Medicare and there are exactly 15 of them. 10 codes for doctor visits (code used determined by new or existing patient, severity of condition, and length of time with the doctor), 4 codes for ophthalmology visits, 1 code for psychotherapy visits. That's it.

So my project (after Dallas gets out of our deep freeze) is to find out what codes they use. Then ask a different office.
 
Seems to be more and more an issue as of late

More and more they want that copay for PT, Never an issue few years ago
 
Seems to be more and more an issue as of late

More and more they want that copay for PT, Never an issue few years ago


All about maxing revenue.

Can't think of a time where someone actually paid $20. $14 or so seems to be the norm.
 
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