Plan N Physical Therapy

[sshafran]

You need to take note of the claim coding comments earlier in the thread.

No, he/she needs to understand N.

 

[sshafran]

Plan N is not a $20.00 co-pay per se, But it is UP to the first
$20.00 for outpatient medical and surgical services and supplies, physical and speech THERAPY , diagnostic tests, durable medical equipment, with that being said a client would pay as an example, PT visit was Medicare part B approved at the amount of $55.00 than the amount the client would owe should be $11.00 TOTAL ,assuming one has already met the part B deductible. ... Also remember that Plan N requires the Part B deductible to be met 1st.

And, you’re wrong. But thanks for playing. We have some nice parting gifts for you...

 

[T Sparks]

So... Tell me were I be wrong then

 

[sshafran]

Plan N is not a $20.00 co-pay per se, But it is UP to the first
$20.00 for outpatient medical and surgical services and supplies, physical and speech THERAPY , diagnostic tests, durable medical equipment, [All incorrect - doctor office visit only for up to $20 - ER up to $50] with that being said a client would pay as an example, PT visit was Medicare part B approved at the amount of $55.00 than the amount the client would owe should be $11.00 TOTAL ,assuming one has already met the part B deductible. ... Also remember that Plan N requires the Part B deductible to be met 1st.

Everything in red is wrong. Blue is correct. Green - my notes.

 

[LostDollar]

The PT biller is coding the treatment as a doctor visit rather than as a PT treatment, which has no copay. Worse, they're using the doc visit code with the highest reimbursement, a long visit for a moderate to high severity condition. Even with Plan N most doc visits should be less than $20. The client needs to have them resubmit the claims correctly.

So... Tell me were I be wrong then

You need to re-read wcmason's post carefully. If still confused search the site for something like wcmason and plan N or wcmason and pt or physical therapy coding. He has given more extensive comments about this issue in other threads. This question comes up regularly for plan N in regard to Physical Therapy and ChemoTherapy visits.