Product Detail

1. Discuss required elements and problem areas of documentation for Therapy and Rehab Services
2. Learn about how to document to support ICD-10-CM diagnosis coding through the use of signs and symptoms to support medical necessity
3. Implement current Medicare fee schedules, payment policy, internet only manuals, LCD’s and NCD’s.
4. Identify procedure codes for rehabilitation services
5. Determine the correct usage of procedures and documentation requirements
6. Discuss CPT and ICD-10 coding for optimal reimbursement
7. Identify upcoming changes to billing and coding
8. Explain effective use of modifiers and coding combinations
9. Discover how place of service affects reimbursement
10. Illustrate tips and techniques for medical record requirements
11. Outline what you must know about physician certification requirements

CPT/HCPCS PROCEDURE CODES and COMPLIANCE WITH DOCUMENTATION STANDARDS

• Provides credentialing resources
• Explore the Revenue Cycle
• Evaluations and Re-Evaluations for Physical Therapy, Occupational Therapy and Speech Services. (Includes tools for changes in criteria.)
• Orders
• Plan of Care, Certification/Re-certification Rules Checklist
• CPT Procedure codes used in Therapy and Rehab
  • Evaluations, re-evaluations, and assessments
  • Supervised modalities
  • Guidelines for billing therapy minutes
  • Constant attendance modalities
  • Therapeutic procedures, included changes in orthotic and prosthetic management and training and development of cognitive skills
  • Speech Pathology Services
  • Neuromuscular procedures
  • Debridement, application of strapping, splints, casts
  • Using HCPCS Level II codes for DME
  • Orthotics billed by hospitals and other providers
  • Lymphedema Service
  • Woundcare
  • Physical Performance Testing 
• Daily Session Note Checklist
• Discharge Checklist 
• NCCI Edits
• Modifiers
• HCPCS II Procedure codes used in Therapy and Rehab
• Functional Limitation Requirements G-codes for functional limitations and severity modifiers – required for outpatient   claims filed to Medicare
• Place of Service Codes

DIAGNOSTIC CODING

• New tools to prepare for ICD-10-CM – Bring your WI-FI enabled device
• Discuss chapters that effect Therapy and Rehab
• Laterality documentation requirements

FEDERAL REGULATIONS MEDICARE'S BILLING RULES and Special Payer News

• Medicare Therapy Cap
• Documentation to meet Medical Necessity in Therapy and Rehab
• Understand changes with congressional changes and their impact on Therapy and Rehab
• Understanding Value-Based Payment issues: (i.e. MACRA, MIPS and APM)
• Explore resources pertaining to CMS MAC, RAC, ZIP, and CERT program guidelines
• OIG audit focus on behavioral health services
• Medicare’s “incident to” guidelines, definition of “incident to” services vs payer supervision
• Overview of Commercial Plans and Therapy Coverage
• Common forms of health care fraud and abuse

COMPLIANCE

• Components of an effective compliance plan
• Understanding recent reports from CMS MAC, RAC, OIG, and GAO to reduce error rates in documentation

UNDERSTANDING THE REIMBURSEMENT PROCESS

• Understanding the claim content 837p and 837i resources
• Explore common revenue codes used with the 837i claims formats
• Learn about the Medicare Learning Network 

THE APPEAL PROCESS

• Understanding reasons for denials
• Systematic steps of responding to an appeal
• Formats for appeal letters

Sherry Marchand, CPMA, is a reimbursement analysis and a billing, collection, and chart-auditing consultant with more than 25 years of experience in the health care industry, including hospital and physician group billing, and collection management. She has served as an expert witness/consultant in Medicare, Medicaid, ALJ hearings, and criminal fraud cases. Her vast knowledge of the practice management process has come from working in various levels of health care accounting, including the management of international hospital billing. As a certified, self-employed practice management consultant and chart auditor, Ms. Marchand has helped numerous medical offices take control of their case flow through implementation of billing and documentation processes. Her specialties include Internal Medicine, Obstetrics, Mental Health, Physical Therapy, Cardiology, ENT, and Surgical Specialties. Ms. Marchand is skilled in installation training and implementation of hardware and software systems that are right for the health care arena. Ms. Marchand has many tips and tools to assist your office on the road to healthy patients and insurance collections.

Speaker Disclosures:

Financial: Sherry Marchand is the owner of Advanced Physician Services. She receives a speaking honorarium from PESI, Inc.

Non-financial: Sherry Marchand is a member of the American Academy of Professional Coders.

Save time and $10 off the price of other submission methods – purchase & take the CE test online for $9.99 USD per participant. Additional processing fees apply for other submission methods (i.e. mail, fax, etc.). Please contact our Customer Service at 1-800-844-8260 for more details.

Listed below are the continuing education credit(s) currently available for this non-interactive self-study package. Please note, your state licensing board dictates whether self study is an acceptable form of continuing education. Please refer to your state rules and regulations.

Certificates of Successful Completion are available for email, download and/or printing from your online account immediately following the successful completion of the post-test/evaluation.

**Materials that are included in this course may include interventions and modalities that are beyond the authorized practice of mental health professionals. As a licensed professional, you are responsible for reviewing the scope of practice, including activities that are defined in law as beyond the boundaries of practice in accordance with and in compliance with your professions standards.

All members of the PESI, Inc. planning committee have provided disclosures of financial relationships with ineligible organizations and any relevant non-financial relationships prior to planning content for this activity. None of the committee members had relevant financial relationships with ineligible companies or other potentially biasing relationships to disclose to learners. For speaker disclosures, please see the faculty biography.

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Nurses/Nurse Practitioners/Clinical Nurse Specialists - Credit Expired: 1/29/2021
No CE available for this board.

California Nurses: PESI, Inc. is a provider approved by the California Board of Registered Nursing, Provider #:17118 for 5.5 self-study contact hours.

You will need to provide your license number to PESI. PESI must have this number on file in order for your hours to be valid.

Florida Nurses: PESI, Inc. is an approved provider by the Florida Board of Nursing. Provider #: FBN2858. These materials qualify for 5.5 self-study contact hours.

Iowa Nurses: PESI, Inc. is an approved provider by the Iowa Board of Nursing. Provider #: 346. Nurses successfully completing these self-study materials will earn 5.8 self-study contact hours.

Copies of the evaluation may be sent to the IBON. You will need to provide your license number to PESI. PESI must have this number on file in order for your hours to be valid.

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Occupational Therapists & Occupational Therapy Assistants
No CE available for this board.

Florida Occupational Therapists & Occupational Therapy Assistant: PESI, Inc. is an approved provider with the Florida Board of Occupational Therapy. Provider Number 50-399. This self-study course qualifies for 5.8 continuing education credits.

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Physical Therapists & Physical Therapist Assistants
This self-study course consists of 5.75 clock hours of instruction that is applicable for physical therapists. CE requirements for physical therapists vary by state/jurisdiction. Please retain the certificate of completion that you receive and use as proof of completion when required.

California Physical Therapists & Physical Therapist Assistants: PESI, Inc. is recognized by the Physical Therapy Board of California as an approval agency to approve providers. This self-study lecture qualifies for 5.75 continuing competency hours.

Illinois Physical Therapists & Physical Therapist Assistants: PESI, Inc. is a Registered Physical Therapy Continuing Education Sponsor through the State of Illinois Department of Financial and Professional Regulation, Division of Professional Regulation. License #: 216.000270. This self-study course qualifies for 5.5 CE credit hours.

New York Physical Therapists & Physical Therapist Assistants: PESI, Inc. is recognized by the New York State Education Department, State Board for Physical Therapy as an approved provider for physical therapy and physical therapy assistant continuing education. This self-study course qualifies for 7.0 contact hours.

Texas Physical Therapists & Physical Therapist Assistants: This self-study activity is provided by the Texas Board of Physical Therapy Examiners Accredited Provider #2106032TX and meets continuing competence requirements for physical therapist and physical therapist assistant licensure renewal in Texas. This activity will provide 5.75 CCUs. The assignment of Texas PT CCUs does not imply endorsement of specific course content, products, or clinical procedures by TPTA or TBPTE. Full attendance is required; no partial credits will be offered for partial attendance.

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Speech-Language Pathologists & Audiologists
This course contains 5.5 hours of self-study continuing education. It was not offered for ASHA CEUs. Please retain your certificate of completion. If audited for ASHA Certification Maintenance, you can submit this certificate of completion at that time. For state licensure, teacher certification renewal, or other credential renewal, contact those agencies for information about your reporting responsibilities and requirements.

California Speech-Language Pathologists/Audiologists: PESI, Inc. is an approved provider with the California Speech-Language Pathology and Audiology Board, #PDP 319. This course meets the qualifications for 5.5 hours of self-study continuing professional development credit for Speech-Language Pathologists or Audiologists, as required by the California Speech-Language Pathology and Audiology Board.

Kansas Speech-Language Pathologists: Approved for 7.0 self-study continuing education clock hours for Kansas licensed Speech-Language Pathologists by the Kansas Department for Aging and Disability Services.

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Other Professions
This self-study activity qualifies for 5.75 clock hours of instructional content as required by many national, state and local licensing boards and professional organizations. Retain your certificate of completion and contact your board or organization for specific filing requirements.

Disclaimer: **Information obtained in this course should be used within your scope of practice.
**It is your ethical responsibility to report accurate hours to your licensing board.
**All self-study participants must complete and pass (80% or better) a post-test and evaluation prior to receiving a certificate of completion. If you require a copy of the test/evaluation for CE purposes, please print at the time you take the test. Or you may call our customer service department and a copy of your test/evaluation will be emailed to you. Please allow 30-45 days.

• Physical Therapists and Assistants
• Occupational Therapists and Assistants
• Speech-Language Pathologists
• Rehab Directors
• Managers and Supervisors
• Billing
• Coding
• Reimbursement Staff
• Administrative Staff
• Physicians
• Nurses
• Medical Assistants