I was shadowing a PT yesterday and the patient arrived 15 minutes late to their scheduled one hour appointment. The patient's insurance company was billed for four 15 minutes of ther ex. Unlike a doctor's office where a patient is billed for the visit, how does it work for physical therapy since they bill in time increments? I am just curious if the way this patient was billed is normal, common practice or if the patient should have only been billed for the time they were actually seen.
Bill for scheduled time or actual time?
- Thread starter trichic
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At my clinic patients can be billed 4 units if they have spent 53minutes with a PT. The minical time spent on one "code" in order to be billed is 8 minutes.
Soooo they are billed for just the time they are there.
Soooo they are billed for just the time they are there.
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Early or late makes no difference. 45 minutes of ther ex is 3 units. As above, a minimum of 53 minutes is needed to bill for 4. If they were late but still seen for 53-67 minutes, then 4 units would be billed.
ETA: Your statements and responses are based solely on what you believe to have witnessed and recounted. Tread carefully in this area of legality, fraud, etc.
ETA: Your statements and responses are based solely on what you believe to have witnessed and recounted. Tread carefully in this area of legality, fraud, etc.
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I wasn't and am not trying to get anyone in trouble. I was just curious if a clinic is allowed to bill for time scheduled when the patient shows up late for their appointment. I would understand why a clinic would want to. This clinic has a PT work one on one with patients. That time is already booked. From the responses, I am assuming that billing this way is not allowed by the insurance companies.
This particular clinic has a form the patient gives to the PT at the beginning of the appointment. At the end of the appointment, the PT writes down how many units of whatever was done for the patient to turn in at checkout. I have seen these forms in this clinic and the PTs have gone over them with me when filling them out. I am also a patient at this clinic and arrived a few minutes late for my appointment time yesterday. The therapist called me back 15 min into my scheduled appointment and I left with 5 minutes left within the hour. When I turned in my sheet, it had 3 units of therapeutic modalities and one unit of manual therapy. I'm not sure how manual therapy and therapeutic modalities are billed. Are they billed the same way as ther ex?
This particular clinic has a form the patient gives to the PT at the beginning of the appointment. At the end of the appointment, the PT writes down how many units of whatever was done for the patient to turn in at checkout. I have seen these forms in this clinic and the PTs have gone over them with me when filling them out. I am also a patient at this clinic and arrived a few minutes late for my appointment time yesterday. The therapist called me back 15 min into my scheduled appointment and I left with 5 minutes left within the hour. When I turned in my sheet, it had 3 units of therapeutic modalities and one unit of manual therapy. I'm not sure how manual therapy and therapeutic modalities are billed. Are they billed the same way as ther ex?
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First off, all of the previous posts are correct, assuming the third party payor has requested the PT provider to use Medicare guidelines. That is certainly not the case with all insurance companies. Medicare does not allow you to bill for the first 7 minutes of an intervention, with the exception of certain treatments which are considered non-time based codes, such as unattended electrical stimulation, etc. So, if I do 8 minutes one-on-one therapeutic exercise with a patient who has Medicare or who has an insurance company that has asked it's PT providers to use Medicare guidelines, I can bill them for one unit of therapeutic exercise. I cannot bill them for another unit of therapuetic exercise until I have been working one-on-one with them for 23 minutes (the initial 15 minute unit, plus another 8 minutes).
So, if the patient doesn't have Medicare, and isn't covered by an insurance company that has requested the providers use Medicare guidelines, then all of this is not applicable.
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This doesn't touch on how long the patient actually stayed. Perhaps the patient arrived 15 minutes late but ended up staying 53 minutes to warrant the 4 units billed.
