Three MUST COVER PT/OT Tasks for the 2020 New Year

There are three tasks that MUST be covered for the new year:

  1. Update patient eligibility and benefits
  2. Establish your deductible/co-insurance collection plan
  3. Initiate the new CMS assistant modifier and required defensive documentation


Systems 4PT Practices: 

  • Use the PET (Patient Eligibility Tool) to verify patient eligibility, coverage end date, copay, deductibles, and co-insurance with one click
  • Note that the Benefits used has been reset to 0 for all applicable Medicare patients
  • Reset the Medicare cap to $2,080

Non-Systems 4PT Practices:

  • Contact the payer for each active patient
    • Verify that coverage is active, verify the end date
    • Verify copay for 2020
    • Verify co-insurance and deductible amounts for 2020
    • Remove the KX modifier for all applicable Medicare patients
    • Reset the Medicare cap to $2,080 for all Medicare patients

All Practices:

Update the number of authorized visits for all applicable commercial or WC patients


Systems 4PT Practices:

Because EMR and billing are integrated into a single database,

  • Confirm that all front desk staff are in “New Year Mode” and are checking the automated “co-insurance and deductibles due” fields in the Patient Processing Screen
  • Emphasize the need to collect these balances on intake with each visit
  • Twice weekly, run integrated reports to monitor patient balances and react accordingly

Non-Integrated EMR/Billing (Web-based PT EMR):

  • Assign front desk staff that must, EVERY DAY:
    • Identify which patients are scheduled for the day
    • For each patient, log into the separate billing software and look up deductible and co-insurance due
      • You may need to pay for “extra log ins” in the separate billing software
    • Create a manual list of amounts due from each patient for that day
    • Collect these amounts on intake
      • Repeat daily
    • Twice weekly, practice directors should log into the separate billing system
      • Review self-pay aging, by patient, if such a report is available
      • React accordingly

Reiterate EVERY DAY that deductibles and coinsurances have “reset.”  Maintain this aggressive co-insurance/deductible collection focus.  Constantly.

  • This will increase/decrease your first-quarter collections by tens of thousands of dollars


  • Confirm that therapists, assistants, and practice directors understand the new CMS modifiers, including the 10% “de minimis” rule
  • Confirm that PTs, OTs, and assistants (PTAs, COTAs) understand the necessity to add the new modifiers on all applicable visits
  • Confirm that therapists and assistants understand the necessity for defensive documentation, clarifying “who delivered how much content for each CPT code”

Refer to the Actual Wording for the CMS Final Rule

“Correct billing requires sufficient documentation in the medical record to support the codes and units reported on the claim, including those reported with and without an assistant modifier… the documentation in the medical record must be sufficient to know whether a specific service was furnished independently by a therapist or a therapist assistant, or was furnished “in part” by a therapist assistant in sufficient detail to permit the determination of whether the 10 percent standard was exceeded.”

Systems 4PT Practices: 

  • Advise staff that the CMS’ assistant modifiers and defense are automated
    • Refer staff to Systems 4PT Software Support Services if they have questions

All Other Practices:

  • Review the 10% de minimis rule
  • Review the CQ vs. CO modifier and how to add it to all applicable patient visits: evals, daily notes, and re-evals
  • Reiterate the protocols for adding modifiers when assistants treat, and reiterate the necessity to document “who delivered what content for each CPT code,” even if assistants were not involved
  • Finally, demonstrate examples of compliant documentation (25- 50 words on each note)

These New Year protocols beg the question:

When it comes to unpaid patient balances, declining collections, Medicare compliance, therapist homework and burnout,

Is your EMR/billing  part of the problem?

Or are they the solution?

Systems 4PT cares about your collections.  We care about your therapists.  And we care about your compliance.

Here’s to a fantastic 2020!

Treat More, Type Less

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