What are some common coding and billing red flags in physical therapy?
Answer
Common coding and billing red flags in physical therapy include discrepancies between documented services and billed codes, billing for more units than time spent with the patient, and lack of medical necessity or skilled intervention in the documentation. Other red flags include billing for services that do not match the patient's documented needs, inconsistent use of CPT codes, and duplicate services billed by different therapists. To avoid these issues, therapists should ensure their documentation accurately reflects the services provided, supports the necessity and skill level of the interventions, and aligns with the billed codes. Regular audits and peer reviews can help identify and correct potential issues before they lead to denied claims or audits.
In her 30+ years of practice, she has worked in rehabilitation and long-term care as an executive, researcher, and educator. She has established numerous programs in nursing facilities and authored peer-reviewed publications on topics such as low vision, dementia, quality care, and wellness. She has spoken at numerous conferences, both nationally and internationally. She provides continuing education support to over 30,000 therapists, nurses, and administrators nationwide as National Director of Education for Select Rehabilitation. She is a Certified Alzheimer’s Disease and Dementia Care Trainer, Certified Dementia Care Practitioner, Certified Montessori Dementia Care Practitioner, Certified Fall Prevention Specialist, a Certified Geriatric Care Practitioner, and Trauma Informed Educator. She serves as the Region 1 Director for the American Occupational Therapy Association Political Action Committee and is an adjunct professor at Gannon University in Erie, PA.
Related Courses
1https://www.physicaltherapy.com/pt-ceus/course/supporting-lgbtq-senior-in-healthcare-4096Supporting the LGBTQ Senior in HealthcareThis training describes the required elements for responding to the emerging needs of long term care communities to provide sensitive and respectful services to LGBT elders. The training reviews definitions related to sexual orientation and gender identity challenges experienced by LGBT older adults, and strategies for communication and policies that honor residents' rights. This course is directly related to the practice of physical therapy and is therefore appropriate for the PT and PTA.auditory, textual, visual129USDSubscriptionUnlimited COURSE Access for $129/yearOnlineOnlyPhysicalTherapy.comwww.physicaltherapy.comSupporting the LGBTQ Senior in HealthcareThis training describes the required elements for responding to the emerging needs of long term care communities to provide sensitive and respectful services to LGBT elders. The training reviews definitions related to sexual orientation and gender identity challenges experienced by LGBT older adults, and strategies for communication and policies that honor residents' rights. This course is directly related to the practice of physical therapy and is therefore appropriate for the PT and PTA.4096OnlinePT120M
This training describes the required elements for responding to the emerging needs of long term care communities to provide sensitive and respectful services to LGBT elders. The training reviews definitions related to sexual orientation and gender identity challenges experienced by LGBT older adults, and strategies for communication and policies that honor residents' rights. This course is directly related to the practice of physical therapy and is therefore appropriate for the PT and PTA.
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Health Literacy is the ability to read, compute, understand and act on health information to make informed decisions. Low health literacy is a serious threat to the well-being of persons seeking medical care. With the increasing diversity of clients, we may observe that our communication skills are less effective with people from backgrounds different from our own. In this course, an overview of health literacy is provided. The session will review techniques for clear and effective communication, verbal and written communication with those from other cultures, writing and selecting easy-to-read health materials, and assessment tools to use to ensure that clients understand the therapy services provided and have the skills needed to access, understand, and use health information.
3https://www.physicaltherapy.com/pt-ceus/course/supervising-assistants-students-and-aides-4377Supervising Assistants, Students, and Aides: Upholding Your Ethics in a Challenging Health Care EnvironmentThis presentation reviews the definitions of supervision as well as APTA guidance related to supervising assistants, students, and aides in various healthcare environments. Documentation guidelines for Medicare are reviewed as these relate to what an assistant can complete versus a therapist. The use of students and rehab aides in long-term care is reviewed in accordance with Medicare guidelines. Real examples of common supervisory ethical dilemmas from the field, including the appropriate action steps to take in each one, are highlighted. This course is directly related to the practice of physical therapy and is therefore appropriate for the PT/PTAauditory, textual, visual129USDSubscriptionUnlimited COURSE Access for $129/yearOnlineOnlyPhysicalTherapy.comwww.physicaltherapy.comSupervising Assistants, Students, and Aides: Upholding Your Ethics in a Challenging Health Care EnvironmentThis presentation reviews the definitions of supervision as well as APTA guidance related to supervising assistants, students, and aides in various healthcare environments. Documentation guidelines for Medicare are reviewed as these relate to what an assistant can complete versus a therapist. The use of students and rehab aides in long-term care is reviewed in accordance with Medicare guidelines. Real examples of common supervisory ethical dilemmas from the field, including the appropriate action steps to take in each one, are highlighted. This course is directly related to the practice of physical therapy and is therefore appropriate for the PT/PTA4377OnlinePT120M
This presentation reviews the definitions of supervision as well as APTA guidance related to supervising assistants, students, and aides in various healthcare environments. Documentation guidelines for Medicare are reviewed as these relate to what an assistant can complete versus a therapist. The use of students and rehab aides in long-term care is reviewed in accordance with Medicare guidelines. Real examples of common supervisory ethical dilemmas from the field, including the appropriate action steps to take in each one, are highlighted. This course is directly related to the practice of physical therapy and is therefore appropriate for the PT/PTA
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The purpose of this course is to prepare Florida healthcare professionals to care for patients with HIV/AIDS based on evidence-based information on HIV/AIDS incidence in Florida, modes of transmission, infection control procedures, clinical management, prevention, and Florida law governing testing and disclosure.
5https://www.physicaltherapy.com/pt-ceus/course/medical-errors-training-5412Medical Errors Training for Florida Healthcare ProfessionalsThe purpose of this course is to provide Florida healthcare practitioners with a review of the types, vulnerable populations, risk factors, and prevention strategies for medical errors, including patient safety, reportable sentinel events, and root cause analysis, and an understanding of Florida’s medical error reporting requirements.auditory, textual, visual129USDSubscriptionUnlimited COURSE Access for $129/yearOnlineOnlyPhysicalTherapy.comwww.physicaltherapy.comMedical Errors Training for Florida Healthcare ProfessionalsThe purpose of this course is to provide Florida healthcare practitioners with a review of the types, vulnerable populations, risk factors, and prevention strategies for medical errors, including patient safety, reportable sentinel events, and root cause analysis, and an understanding of Florida’s medical error reporting requirements.5412OnlinePT120M
The purpose of this course is to provide Florida healthcare practitioners with a review of the types, vulnerable populations, risk factors, and prevention strategies for medical errors, including patient safety, reportable sentinel events, and root cause analysis, and an understanding of Florida’s medical error reporting requirements.
