Billing Brilliance: How PM&R Physicians Can Navigate Inpatient Billing Changes with Ease (enduring)-Billing Brilliance: Q&A

Billing Brilliance: Q&A

Pdf Summary

This document comprises a Q&A session focused on billing changes and guidelines that affect Physical Medicine and Rehabilitation (PM&R) physicians, particularly in the inpatient setting. Key topics addressed include the utilization of data points, specialty-specific interactions, and the impact of these factors on evaluation and management (E/M) coding.<br /><br />**Specialty Interaction:** <br />- If group members have different specialties, both can utilize the same data point for their E/M levels.<br />- Reviewing therapy notes from an entity like the Inpatient Rehabilitation Facility (IRF) counts as one data point as long as it is from a qualified external provider.<br />- Discussions and reviews with practitioners from different specialties within the same group practice count towards data points. However, engagements with internists within the same specialty do not.<br /><br />**Review of Data:**<br />- Reviewing notes from specialties like nephrology in an inpatient setting is counted as a data point.<br />- Discussions with physical/occupational therapists (PT/OT) at the same rehab are considered in data points if an interactive exchange occurs.<br />- Providers must document how therapy note reviews impact their decision-making.<br /><br />**Guidelines for Practitioners:**<br />- When covering for someone in the same specialty but different group National Provider Identifier (NPI), it is considered the same group for billing purposes.<br />- For discharge work, if the discharge work occurs but the patient is seen later, a subsequent visit code should be used.<br />- Reviewing and interpreting data from other healthcare professionals (e.g., PT/OT/ST, case managers) count towards data points.<br /><br />**Risk Management & Drug Management:**<br />- Decisions on hospitalization count as high-risk activities, but discussions about the length of stay during team meetings do not.<br />- Managing prescription drugs includes documenting efficacy and providing specific actions, enhancing audit compliance.<br />- Continuing medications count as management, but details like linking the condition to the medication and a brief effectiveness review are recommended.<br /><br />**Billing Time:**<br />- Exact minutes should be documented for time-based billing instead of approximate durations.<br />- Split/shared visits require only one practitioner to have face-to-face time with the patient.<br /><br />Overall, the document highlights the complexities of billing for inpatient care and the significance of proper documentation to ensure compliance and accurate billing under updated guidelines effective from 2023.

Keywords

billing changes

Physical Medicine and Rehabilitation

inpatient setting

E/M coding

data points

specialty interaction

therapy notes

guidelines

risk management

billing time