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  • CMS Releases National Comparative Billing Report for Outpatient Physical Therapy Services

    The Centers for Medicare and Medicaid Services (CMS) recently released a national provider Comparative Billing Report (CBR) that centered on independent physical therapy providers who practice in the outpatient setting and bill Medicare with the KX Modifier. This CBR is similar to an original study distributed last summer, though this current study focuses on 2010 billing data and is being sent to 5,000 additional or different providers.

    Specifically, these CBRs address the use of the KX modifier for 5 codes that are commonly billed by physical therapists. The CBRs are produced by Safeguard Services under contract with CMS and contain data-driven tables and graphs with an explanation of findings that compare nationally and statewide physical therapist billing and payment patterns with the KX modifier. Safeguard Services has indicated to APTA that these reports are only educational rather than punitive, intending to prevent improper billing and use of the KX modifier.

    To help physical therapists understand these reports, Safeguard Services is conducting a free audioconference on September 20, 2 pm Eastern Time. Physical therapists will be able to ask questions directly to the company that produced the reports.

    For more information and to review a sample of the Outpatient Physical Therapy Services CBR with service dates from January 1, 2009, through December 31, 2009, visit CBR Services' Web site or call the SafeGuard Services' provider help desk, CBR support team, at 530/896-7080.


    • CMS sometimes does something proper and right, and sometimes they get goofier and goofier. When working in Home Health, we got red flagged for review because, "You bill the same codes over and over again." Yeah? When you see hip and knee replacement patients primarily, they all usually require some mixture of THE SAME PROCEDURES! That'd be why you see many of the same procedure codes billed repetitively. It's like getting a compass and conducting an audit of the sun, because it comes up in the same spot every day, unless it's cloudy.

      Posted by Leon Richard on 8/19/2011 5:38 PM

    • I agree with Leon Richard's comment. A PT is there is provide services for patients who are necessitating the same procedures and until a progress change has occurred which the therapist should be looking up to which I believe does not take more than 4 weeks max and will be looking up to the change of another treatment procedure to gain more progress OR a plateau and appropriate recommendations for appropriate treatment must occur. However, active medical interventions whether educational to other diagnostic interventions should occur. The lifestyle, occupation (if adult)of the patient plays a big role in the progress change of the patient. CMS has obligated itself to provide reimbursement to health services to its member and must fulfill them, rather than make a cut on the provider! Wouldn't they rather educate their members then on why the cut off?

      Posted by Agnes Vigilia-Maraya on 8/20/2011 9:43 AM

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