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National Correct Coding Initiative (NCCI) edits are used by the Medicare program, state Medicaid programs as well as some commercial insurance carriers and workers compensation carriers to combat abusive and fraudulent billing practices in outpatient therapy as well as other services. Modifier 59 is used by outpatient therapy providers to bypass certain NCCI edits and allow the payment of more than 1 CPT code billed on the same day that an insurance carrier may consider should be bundled and separate payment should not be made. Because of this, modifier 59 is not only the most commonly used modifier, it is also the most commonly abused modifier. In addition, the need to use modifier 59 is not only within the same discipline but may also be required when a patient is receiving multiple disciplines from the same provider on the same date of service. Version 27.0 becomes effective with dates of service between January 1 – March 31, 2021.
This 1-hour webinar program will explain NCCI edits, the use of modifier 59 and what code(s) to append modifier 59 to on the claim form as well as provide the participants with the significant changes to the procedure-to-procedure (PTP) edits effective beginning on January 1, 2021 that will impact outpatient physical, occupational and speech therapy services. One of the major changes involves the billing and payment of a physical or occupational therapy evaluation or re-evaluation on the same date of service the hospital bills for an emergency room visit on a Medicare beneficiary. In addition, the webinar will provide detailed and realistic examples when providers of outpatient therapy services would utilize modifier 59. Examples will include all 3 disciplines as well as how speech therapy billing impacts the physical and occupational therapy codes billed the same day. Lastly, participants will receive Gawenda Seminars & Consulting NCCI Version 27.0 “cheat sheet” to assist them in knowing when to apply modifier 59 to a CPT code on the claim form. In addition, the webinar will explain how the reinstated NCCI edits will impact the billing of outpatient therapy services to commercial insurance carriers such as Aetna, Anthem BC, Humana and many others.
At the conclusion of this webinar presentation, participants will be able to:
- Describe and understand column 1/column 2 NCCI edits and which CPT code(s) requires modifier 59
- Be able to use the NCCI edit “cheat sheet” to append modifier-59 to the correct CPT code(S) on the claim form
- Recite how one discipline’s billing may cause another discipline’s billing to require modifier 59
- Understand the documentation that must be present in the medical record to support the use of modifier 59
- Identify at least 5 changes to NCCI edits as they pertain to outpatient physical, occupational and speech therapy services with Version 27.0 compared to Version 26.3
- Summarize the current payment status of a physical or occupational therapy evaluation or reevaluation when billed on the same date of service as an emergency department visit
ABOUT THE SPEAKER:
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. and Director of Finances for Kinetix Advanced Physical Therapy Inc., a private practice located in southern California. 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.gawendaseminars.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”.
WHO SHOULD LISTEN:
Physical therapists, physical therapist assistants, occupational therapists, occupational therapy assistants, speech-language pathologists, private practice owners and practice administrators, coders 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, schools, rehabilitation agencies, home health agencies, and comprehensive outpatient rehabilitation facilities.
INCLUDED IN YOUR MATERIALS PACKET:
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 as well as Gawenda Seminars & Consulting NCCI Edit Version 27.0 “Cheat Sheet” for use of modifier 59 in outpatient therapy.
A certificate of attendance will be available upon purchase of the webinar 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 listened to via a playback link of the live presentation that occurred on January 6, 2021.
LENGTH OF TIME FOR PLAYBACK or AUDIO FILES:
Time: Approximately 1 hour (including Q&A time recorded)
There are no refunds once your order has been processed since the handouts/links will be emailed to you immediately after your order has been completed.
System Requirements Required To View Webinar Playback Link On Computer: 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
- Disabled pop-up blockers
- Computer speakers for participants
Note: Android Smart Phones (i.e. IPhone) are not compatible.
In order to ensure 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 at firstname.lastname@example.org for pricing.
If you have questions about registration or logistics for this webinar conference, please contact the Webinar Conference Manager:
Michelle Gawenda at 661.350.6187 or contact Rick or Michelle via email by filling out our contact form.