Insurance payers are increasingly reviewing therapy claims to ensure that the therapy provided to the beneficiary required the skills of a therapist, was billed appropriately and the required documentation was present in the patient’s medical record. The Centers for Medicare and Medicaid Services continue to focus their efforts on reducing inappropriate payments to providers of therapy services in all settings. The Office of the Inspector General continues to focus on outpatient therapy services in their yearly work plans. Congress authorized the Recovery Audit Contractors to be a mandated program due to the extreme success of recovering nearly 1 billion dollars during the 3-year demonstration project. An accurate understanding of the coding and documentation process is critical for rehab professionals to ensure that they are paid correctly and in a timely manner if medical records are reviewed prior to payment and will keep their money upon a post-payment medical record audit.

Outpatient Therapy CPT Coding, Billing and Documentation for Rehabilitation Reimbursement covers the correct use of CPT codes, G and L Level II codes, and modifiers used by Physical and Occupational Therapists as well as Speech-Language Pathologists in all outpatient settings including private practice, hospital-based, rehab agencies, comprehensive outpatient rehabilitation facilities, skilled nursing facilities and in a patient's home. The course also covers ICD-9-CM coding guidelines as they pertain to outpatient therapy services. Billing scenarios are discussed and reviewed to ensure therapists can accurately charge patients correctly for their services. This course also examines the most common reasons claims are denied for all payers and thoroughly reviews Medicare Part B and other third party payer documentation guidelines for initial evaluations, re-evaluations, progress and discharge reports, daily notes, certifications/recertifications and plan of care. Resources and references are provided to assist therapists and assistants to stay current with the ever-changing reimbursement guidelines and regulations as they pertain to outpatient therapy services.