Since 2018, inflation has risen by 22%. This means what took $1.00 to purchase an item in 2018 now takes $1.22 to purchase the same item in 2023. Unfortunately, insurance reimbursement has not risen 22% over the same 5-year period. In fact, taking into account inflation, you are actually being paid less in 2023 than you were in 2018, yet your expenses, especially health insurance, have increased drastically. For example, the Medicare conversion factor has decreased 9% since 2018.
Due to this inverse relationship, more and more physical therapists (PTs), occupational therapists (OTs), and speech-language pathologists (SLPs) have decided to either unenroll or not enroll with Medicare Advantage plans and commercial insurance carriers. This is known as being out-of-network (OON). However, many PTs, OTs and SLPs do not understand how to bill when they are out-of-network with an insurance plan.
This 1-hour webinar will teach participants the correct way to bill a patient for an outpatient therapy visit when the provider is not enrolled with the patient’s insurance carrier. In addition, the webinar will teach participants what they must still do each visit regarding documentation and billing even though they have no contractual relationship with the insurance carrier.
At the conclusion of this webinar presentation, participants will be able to:
- Describe the difference between In-Network and Out-of-Network with an insurance carrier
- Understand limitations of collecting payment from some Medicare Advantage beneficiaries
- Recite documentation requirements if you are out-of-network with an insurance carrier or plan
- Identify what information you must provide to a patient who is submitting a claim to their insurance carrier
- Explain the difference between accepting assignment and not accepting assignment
- Summarize what information an insurance carrier may or may not be able to share with you if you have no contractual relationship with that insurance carrier
- Determine if the patient pays you at the time of service versus the insurance carrier reimbursing you
Rick Gawenda, P.T., graduated in 1991 with a Bachelor of Science in Physical Therapy from Wayne State University, Detroit, Michigan. Mr. Gawenda is currently the President and founder of Gawenda Seminars & Consulting, Inc. He has provided valuable education and consulting to hospitals, rehabilitation agencies, private practices, nursing homes, and his peers in the areas of CPT and ICD-10 coding, billing, documentation, reimbursement, and compliance as it pertains to outpatient therapy services as well as denial management and the appeals process for Medicare denied claims. Mr. Gawenda’s website, www.woocommerce-345137-2568417.cloudwaysapps.com, provides a valuable source of information on rehabilitation rules and regulations, coding, documentation, and reimbursement.
Mr. Gawenda is a member of the American Physical Therapy Association (APTA) and Michigan Physical Therapy Association (MPTA). Mr. Gawenda is the Past President of the Section on Health Policy & Administration of the APTA as well as Past President of the Michigan Association of Medical Rehabilitation Program Administrators.
Mr. Gawenda is also the author of “The How-To Manual for Rehab Documentation: A Complete Guide to Increasing Reimbursement and Reducing Denials” and “Coding and Billing For Outpatient Rehab Made Easy: Proper Use of CPT Codes, ICD-9 Codes and Modifiers”.
Physical therapists, physical therapist assistants, occupational therapists, occupational therapy assistants, speech-language pathologists, private practice owners and practice administrators, and office managers at private practices, as well as directors, managers, supervisors, compliance officers, risk managers, and billers in skilled nursing facilities, hospital outpatient therapy departments, rehabilitation agencies, home health agencies, and comprehensive outpatient rehabilitation facilities.
In addition to the expertise and advice presented during this webinar conference, you’ll also receive a handout (in PDF format) that will include related reference links.
This webinar has not been submitted to any state board or national organization for CEU approval. A certificate of attendance will be available upon completion of the webinar for each participant and may be adequate for credit in some states; you will need to contact your state licensing regulatory body to determine whether or not credit will be granted for this webinar conference. We provide no additional information for CEU approval.
Time: Approximately 1 hour and 21 minutes (including Q&A time recorded)
There are no refunds for no shows or any other reasons once you register and payment is received. We are not responsible for organization firewalls or computer software issues that may interfere and/or prohibit your connection to the webinar portion of the presentation.
Venue system requirements:
- Microsoft Internet Explorer 7+, Mozilla Firefox 2.5+, Safari, or Chrome
- 1024 x 768 screen resolution
- Stable Internet connection, DSL or above
- Wired Internet connection; wireless is not recommended
- Flash Player 9 or higher
- Disable pop-up blockers
- Computer speakers for participants
Note: Android Smart Phones (i.e. iPhone) are not compatible.
In order to ensure a successful connection to the playback webinar link, please take a moment to conduct a system test by clicking this link: http://web.telspan.com/systemcheck
***Application Sharing does not need to be operational in order to view this webinar playback link.
*** This WEBINAR PLAYBACK LINK and HANDOUTS is not to be distributed outside of your organization. If you have a larger organization and have multiple locations, then please contact us here for pricing.
