{"id":7517,"date":"2020-01-06T10:10:42","date_gmt":"2020-01-06T15:10:42","guid":{"rendered":"https:\/\/systems4pt.com\/staging\/?p=7517"},"modified":"2020-02-28T13:58:04","modified_gmt":"2020-02-28T18:58:04","slug":"surprise-cms-coding-changes-are-lowering-pt-and-ot-reimbursements","status":"publish","type":"post","link":"https:\/\/systems4pt.com\/staging\/surprise-cms-coding-changes-are-lowering-pt-and-ot-reimbursements\/","title":{"rendered":"Surprise CMS Coding Changes Are Lowering PT and OT Reimbursements"},"content":{"rendered":"

Surprise CMS Coding Changes Are <\/strong>Lowering PT and OT Reimbursements<\/strong><\/h1>\n

On Thursday Jan 2nd <\/sup>Medicare announced two coding changes related to billing Medicare evaluations.<\/p>\n

Not complying with these changes will result in lower reimbursements.<\/p>\n

Systems 4PT has automated the workflows related to both rules.\u00a0 Here\u2019s what\u2019s changed:<\/p>\n

New Medicare Change #1:<\/span><\/strong><\/p>\n

If the payer is Medicare, and if 97140 is charged on the eval visit, the 97140 code must be accompanied with the 59 modifier, which must be defended in the documentation.<\/span><\/strong><\/p>\n

If the 59 modifier does not accompany 97140 on an eval, 97140 is not reimbursed.<\/span><\/strong><\/p>\n

New Medicare Change #2:<\/span><\/strong><\/p>\n

If the payer is Medicare, neither 97530 or 97150 can be charged on the eval visit.<\/span><\/strong><\/p>\n

If either 97530 or 97150 are charged on the eval visit, the codes will not be reimbursed.<\/span><\/strong><\/p>\n

Obviously, these are widely used CPT codes and the two new changes listed above threaten to erode your Medicare payments.<\/strong><\/p>\n

How To Fix It:<\/h3>\n

Over the weekend, Systems 4PT installed HardStop™ validation that warns therapists if they are charging Medicare 97140, 97530 or 97150 together with an evaluation code.<\/p>\n

    \n
  • If the medical necessity for 97140 is documented, Systems 4PT adds the 59 modifier automatically and the code is fully paid<\/li>\n
  • HardStop™ technology blocks therapists from signing a Medicare eval if 97530 or 97150 are charged\n
      \n
    • Validation then guides therapists toward other compliant and defensible coding options that will be fully paid<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n

      This technology was in place at 11:50 pm on Sunday night, January 5th<\/sup>.<\/p>\n

      No other EMR has either acknowledged the Medicare coding surprises or delivered workflows that protect the practice.<\/p>\n

      This leaves their practices with two options:<\/p>\n

        \n
      • Submit non-compliant coding that doesn\u2019t get paid, or<\/li>\n
      • Absorb further inefficiencies by setting up a system of checks and balances that assures compliance<\/li>\n<\/ul>\n

        We\u2019re glad that we spent our New Year’s weekend <\/strong><\/span><\/p>\n

        keeping our practices compliant, fully paid, and safe.<\/strong><\/span><\/p>\n

        You don\u2019t have to fear healthcare reform when your EMR has your back. <\/strong><\/span><\/p>\n

        Systems 4PT has your back.
        \n<\/strong><\/span><\/p>\n<\/div>

        Sign Up for a Free Demo<\/strong><\/h2>\n<\/div>[contact-form-7 id=\"5393\" title=\"Free Demo_copy\"][fusion_blog layout=”grid” blog_grid_columns=”” blog_grid_column_spacing=”” blog_masonry_grid_ratio=”” blog_masonry_width_double=”” equal_heights=”yes” number_posts=”3″ offset=”0″ pull_by=”category” cat_slug=”” exclude_cats=”” tag_slug=”” exclude_tags=”” orderby=”date” order=”DESC” thumbnail=”yes” title=”yes” title_link=”yes” content_alignment=”” excerpt=”” excerpt_length=”10″ strip_html=”yes” meta_all=”no” meta_author=”yes” meta_categories=”yes” meta_comments=”yes” meta_date=”yes” meta_link=”yes” meta_tags=”yes” scrolling=”pagination” grid_box_color=”” grid_element_color=”” grid_separator_style_type=”” grid_separator_color=”” padding_top=”” padding_right=”” padding_bottom=”” padding_left=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” class=”” id=”” \/]<\/div><\/div><\/div><\/div>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":7518,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"content-type":"","footnotes":""},"categories":[56],"tags":[50],"class_list":["post-7517","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-general","tag-billing"],"yoast_head":"\nSurprise CMS Coding Changes Are Lowering PT and OT Reimbursements - Systems4PT<\/title>\n<meta name=\"robots\" content=\"noindex, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Surprise CMS Coding Changes Are Lowering PT and OT Reimbursements\" \/>\n<meta property=\"og:url\" content=\"https:\/\/systems4pt.com\/staging\/surprise-cms-coding-changes-are-lowering-pt-and-ot-reimbursements\/\" \/>\n<meta property=\"og:site_name\" content=\"Systems4PT\" \/>\n<meta property=\"article:published_time\" content=\"2020-01-06T15:10:42+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2020-02-28T18:58:04+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/systems4pt.com\/staging\/wp-content\/uploads\/2020\/01\/AdobeStock_234265489.jpeg\" \/>\n\t<meta property=\"og:image:width\" content=\"2560\" \/>\n\t<meta property=\"og:image:height\" content=\"1707\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/jpeg\" \/>\n<meta name=\"author\" content=\"Systems4PT\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"Systems4PT\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"3 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\/\/systems4pt.com\/staging\/surprise-cms-coding-changes-are-lowering-pt-and-ot-reimbursements\/#article\",\"isPartOf\":{\"@id\":\"https:\/\/systems4pt.com\/staging\/surprise-cms-coding-changes-are-lowering-pt-and-ot-reimbursements\/\"},\"author\":{\"name\":\"Systems4PT\",\"@id\":\"https:\/\/systems4pt.com\/staging\/#\/schema\/person\/cbd6a79a0c6efcdf4bf949f37beca785\"},\"headline\":\"Surprise CMS Coding Changes Are Lowering PT and OT Reimbursements\",\"datePublished\":\"2020-01-06T15:10:42+00:00\",\"dateModified\":\"2020-02-28T18:58:04+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\/\/systems4pt.com\/staging\/surprise-cms-coding-changes-are-lowering-pt-and-ot-reimbursements\/\"},\"wordCount\":690,\"publisher\":{\"@id\":\"https:\/\/systems4pt.com\/staging\/#organization\"},\"image\":{\"@id\":\"https:\/\/systems4pt.com\/staging\/surprise-cms-coding-changes-are-lowering-pt-and-ot-reimbursements\/#primaryimage\"},\"thumbnailUrl\":\"https:\/\/systems4pt.com\/staging\/wp-content\/uploads\/2020\/01\/AdobeStock_234265489.jpeg\",\"keywords\":[\"Billing\"],\"articleSection\":[\"General\"],\"inLanguage\":\"en\"},{\"@type\":\"WebPage\",\"@id\":\"https:\/\/systems4pt.com\/staging\/surprise-cms-coding-changes-are-lowering-pt-and-ot-reimbursements\/\",\"url\":\"https:\/\/systems4pt.com\/staging\/surprise-cms-coding-changes-are-lowering-pt-and-ot-reimbursements\/\",\"name\":\"Surprise CMS Coding Changes Are Lowering PT and OT Reimbursements - Systems4PT\",\"isPartOf\":{\"@id\":\"https:\/\/systems4pt.com\/staging\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\/\/systems4pt.com\/staging\/surprise-cms-coding-changes-are-lowering-pt-and-ot-reimbursements\/#primaryimage\"},\"image\":{\"@id\":\"https:\/\/systems4pt.com\/staging\/surprise-cms-coding-changes-are-lowering-pt-and-ot-reimbursements\/#primaryimage\"},\"thumbnailUrl\":\"https:\/\/systems4pt.com\/staging\/wp-content\/uploads\/2020\/01\/AdobeStock_234265489.jpeg\",\"datePublished\":\"2020-01-06T15:10:42+00:00\",\"dateModified\":\"2020-02-28T18:58:04+00:00\",\"breadcrumb\":{\"@id\":\"https:\/\/systems4pt.com\/staging\/surprise-cms-coding-changes-are-lowering-pt-and-ot-reimbursements\/#breadcrumb\"},\"inLanguage\":\"en\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\/\/systems4pt.com\/staging\/surprise-cms-coding-changes-are-lowering-pt-and-ot-reimbursements\/\"]}]},{\"@type\":\"ImageObject\",\"inLanguage\":\"en\",\"@id\":\"https:\/\/systems4pt.com\/staging\/surprise-cms-coding-changes-are-lowering-pt-and-ot-reimbursements\/#primaryimage\",\"url\":\"https:\/\/systems4pt.com\/staging\/wp-content\/uploads\/2020\/01\/AdobeStock_234265489.jpeg\",\"contentUrl\":\"https:\/\/systems4pt.com\/staging\/wp-content\/uploads\/2020\/01\/AdobeStock_234265489.jpeg\",\"width\":2560,\"height\":1707},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\/\/systems4pt.com\/staging\/surprise-cms-coding-changes-are-lowering-pt-and-ot-reimbursements\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\/\/systems4pt.com\/staging\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Surprise CMS Coding Changes Are Lowering PT and OT Reimbursements\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\/\/systems4pt.com\/staging\/#website\",\"url\":\"https:\/\/systems4pt.com\/staging\/\",\"name\":\"Systems4PT\",\"description\":\"Physical Therapy Software: Scheduling, EMR and Billing\",\"publisher\":{\"@id\":\"https:\/\/systems4pt.com\/staging\/#organization\"},\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\/\/systems4pt.com\/staging\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"en\"},{\"@type\":\"Organization\",\"@id\":\"https:\/\/systems4pt.com\/staging\/#organization\",\"name\":\"Systems4PT\",\"alternateName\":\"S4PT\",\"url\":\"https:\/\/systems4pt.com\/staging\/\",\"logo\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en\",\"@id\":\"https:\/\/systems4pt.com\/staging\/#\/schema\/logo\/image\/\",\"url\":\"https:\/\/systems4pt.com\/staging\/wp-content\/uploads\/2023\/06\/cropped-favicon-avada-512x512-6.png\",\"contentUrl\":\"https:\/\/systems4pt.com\/staging\/wp-content\/uploads\/2023\/06\/cropped-favicon-avada-512x512-6.png\",\"width\":512,\"height\":512,\"caption\":\"Systems4PT\"},\"image\":{\"@id\":\"https:\/\/systems4pt.com\/staging\/#\/schema\/logo\/image\/\"}},{\"@type\":\"Person\",\"@id\":\"https:\/\/systems4pt.com\/staging\/#\/schema\/person\/cbd6a79a0c6efcdf4bf949f37beca785\",\"name\":\"Systems4PT\",\"image\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en\",\"@id\":\"https:\/\/systems4pt.com\/staging\/#\/schema\/person\/image\/\",\"url\":\"https:\/\/secure.gravatar.com\/avatar\/1373afdc7d5dc0851bb1478a44d4a874?s=96&d=mm&r=g\",\"contentUrl\":\"https:\/\/secure.gravatar.com\/avatar\/1373afdc7d5dc0851bb1478a44d4a874?s=96&d=mm&r=g\",\"caption\":\"Systems4PT\"},\"url\":\"https:\/\/systems4pt.com\/staging\/author\/systemsadmin4pt\/\"}]}<\/script>\n<!-- \/ Yoast SEO Premium plugin. -->","yoast_head_json":{"title":"Surprise CMS Coding Changes Are Lowering PT and OT Reimbursements - Systems4PT","robots":{"index":"noindex","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"og_locale":"en_US","og_type":"article","og_title":"Surprise CMS Coding Changes Are Lowering PT and OT Reimbursements","og_url":"https:\/\/systems4pt.com\/staging\/surprise-cms-coding-changes-are-lowering-pt-and-ot-reimbursements\/","og_site_name":"Systems4PT","article_published_time":"2020-01-06T15:10:42+00:00","article_modified_time":"2020-02-28T18:58:04+00:00","og_image":[{"width":2560,"height":1707,"url":"https:\/\/systems4pt.com\/staging\/wp-content\/uploads\/2020\/01\/AdobeStock_234265489.jpeg","type":"image\/jpeg"}],"author":"Systems4PT","twitter_card":"summary_large_image","twitter_misc":{"Written by":"Systems4PT","Est. reading time":"3 minutes"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"Article","@id":"https:\/\/systems4pt.com\/staging\/surprise-cms-coding-changes-are-lowering-pt-and-ot-reimbursements\/#article","isPartOf":{"@id":"https:\/\/systems4pt.com\/staging\/surprise-cms-coding-changes-are-lowering-pt-and-ot-reimbursements\/"},"author":{"name":"Systems4PT","@id":"https:\/\/systems4pt.com\/staging\/#\/schema\/person\/cbd6a79a0c6efcdf4bf949f37beca785"},"headline":"Surprise CMS Coding Changes Are Lowering PT and OT Reimbursements","datePublished":"2020-01-06T15:10:42+00:00","dateModified":"2020-02-28T18:58:04+00:00","mainEntityOfPage":{"@id":"https:\/\/systems4pt.com\/staging\/surprise-cms-coding-changes-are-lowering-pt-and-ot-reimbursements\/"},"wordCount":690,"publisher":{"@id":"https:\/\/systems4pt.com\/staging\/#organization"},"image":{"@id":"https:\/\/systems4pt.com\/staging\/surprise-cms-coding-changes-are-lowering-pt-and-ot-reimbursements\/#primaryimage"},"thumbnailUrl":"https:\/\/systems4pt.com\/staging\/wp-content\/uploads\/2020\/01\/AdobeStock_234265489.jpeg","keywords":["Billing"],"articleSection":["General"],"inLanguage":"en"},{"@type":"WebPage","@id":"https:\/\/systems4pt.com\/staging\/surprise-cms-coding-changes-are-lowering-pt-and-ot-reimbursements\/","url":"https:\/\/systems4pt.com\/staging\/surprise-cms-coding-changes-are-lowering-pt-and-ot-reimbursements\/","name":"Surprise CMS Coding Changes Are Lowering PT and OT Reimbursements - Systems4PT","isPartOf":{"@id":"https:\/\/systems4pt.com\/staging\/#website"},"primaryImageOfPage":{"@id":"https:\/\/systems4pt.com\/staging\/surprise-cms-coding-changes-are-lowering-pt-and-ot-reimbursements\/#primaryimage"},"image":{"@id":"https:\/\/systems4pt.com\/staging\/surprise-cms-coding-changes-are-lowering-pt-and-ot-reimbursements\/#primaryimage"},"thumbnailUrl":"https:\/\/systems4pt.com\/staging\/wp-content\/uploads\/2020\/01\/AdobeStock_234265489.jpeg","datePublished":"2020-01-06T15:10:42+00:00","dateModified":"2020-02-28T18:58:04+00:00","breadcrumb":{"@id":"https:\/\/systems4pt.com\/staging\/surprise-cms-coding-changes-are-lowering-pt-and-ot-reimbursements\/#breadcrumb"},"inLanguage":"en","potentialAction":[{"@type":"ReadAction","target":["https:\/\/systems4pt.com\/staging\/surprise-cms-coding-changes-are-lowering-pt-and-ot-reimbursements\/"]}]},{"@type":"ImageObject","inLanguage":"en","@id":"https:\/\/systems4pt.com\/staging\/surprise-cms-coding-changes-are-lowering-pt-and-ot-reimbursements\/#primaryimage","url":"https:\/\/systems4pt.com\/staging\/wp-content\/uploads\/2020\/01\/AdobeStock_234265489.jpeg","contentUrl":"https:\/\/systems4pt.com\/staging\/wp-content\/uploads\/2020\/01\/AdobeStock_234265489.jpeg","width":2560,"height":1707},{"@type":"BreadcrumbList","@id":"https:\/\/systems4pt.com\/staging\/surprise-cms-coding-changes-are-lowering-pt-and-ot-reimbursements\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/systems4pt.com\/staging\/"},{"@type":"ListItem","position":2,"name":"Surprise CMS Coding Changes Are Lowering PT and OT Reimbursements"}]},{"@type":"WebSite","@id":"https:\/\/systems4pt.com\/staging\/#website","url":"https:\/\/systems4pt.com\/staging\/","name":"Systems4PT","description":"Physical Therapy Software: Scheduling, EMR and Billing","publisher":{"@id":"https:\/\/systems4pt.com\/staging\/#organization"},"potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/systems4pt.com\/staging\/?s={search_term_string}"},"query-input":{"@type":"PropertyValueSpecification","valueRequired":true,"valueName":"search_term_string"}}],"inLanguage":"en"},{"@type":"Organization","@id":"https:\/\/systems4pt.com\/staging\/#organization","name":"Systems4PT","alternateName":"S4PT","url":"https:\/\/systems4pt.com\/staging\/","logo":{"@type":"ImageObject","inLanguage":"en","@id":"https:\/\/systems4pt.com\/staging\/#\/schema\/logo\/image\/","url":"https:\/\/systems4pt.com\/staging\/wp-content\/uploads\/2023\/06\/cropped-favicon-avada-512x512-6.png","contentUrl":"https:\/\/systems4pt.com\/staging\/wp-content\/uploads\/2023\/06\/cropped-favicon-avada-512x512-6.png","width":512,"height":512,"caption":"Systems4PT"},"image":{"@id":"https:\/\/systems4pt.com\/staging\/#\/schema\/logo\/image\/"}},{"@type":"Person","@id":"https:\/\/systems4pt.com\/staging\/#\/schema\/person\/cbd6a79a0c6efcdf4bf949f37beca785","name":"Systems4PT","image":{"@type":"ImageObject","inLanguage":"en","@id":"https:\/\/systems4pt.com\/staging\/#\/schema\/person\/image\/","url":"https:\/\/secure.gravatar.com\/avatar\/1373afdc7d5dc0851bb1478a44d4a874?s=96&d=mm&r=g","contentUrl":"https:\/\/secure.gravatar.com\/avatar\/1373afdc7d5dc0851bb1478a44d4a874?s=96&d=mm&r=g","caption":"Systems4PT"},"url":"https:\/\/systems4pt.com\/staging\/author\/systemsadmin4pt\/"}]}},"_links":{"self":[{"href":"https:\/\/systems4pt.com\/staging\/wp-json\/wp\/v2\/posts\/7517","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/systems4pt.com\/staging\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/systems4pt.com\/staging\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/systems4pt.com\/staging\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/systems4pt.com\/staging\/wp-json\/wp\/v2\/comments?post=7517"}],"version-history":[{"count":5,"href":"https:\/\/systems4pt.com\/staging\/wp-json\/wp\/v2\/posts\/7517\/revisions"}],"predecessor-version":[{"id":7523,"href":"https:\/\/systems4pt.com\/staging\/wp-json\/wp\/v2\/posts\/7517\/revisions\/7523"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/systems4pt.com\/staging\/wp-json\/wp\/v2\/media\/7518"}],"wp:attachment":[{"href":"https:\/\/systems4pt.com\/staging\/wp-json\/wp\/v2\/media?parent=7517"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/systems4pt.com\/staging\/wp-json\/wp\/v2\/categories?post=7517"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/systems4pt.com\/staging\/wp-json\/wp\/v2\/tags?post=7517"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}