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LIVE from the Ascend Conference in Washington DC, Rick Gawenda joins me on this episode to discuss the CPT codes. Rick Gawenda, PT, is a licensed physical therapist with 25 years of experience and currently serves as the founder and President of Gawenda Seminars & Consulting, Inc. He has provided valuable education and consulting to hospitals, private practices, skilled nursing facilities, and rehabilitation agencies in the areas of CPT coding, ICD-10 coding, billing, documentation compliance, revenue enhancement, practice management, and denial management as they relate to outpatient therapy services.
In this episode, we discuss:
-The 4 components to determine levels of CPT Codes: history, examination, clinical presentation, decision making
-Differentiating the complexity levels of CPT Codes with patient case studies
-Challenges with billing higher complexity levels differently than lower complexity levels
-Common myths surrounding the treatment of Medicare patients
-And so much more!
Therapists are not documenting relevant patient co-morbidities and clinical presentation. Rick finds, “We are underestimating the complexity level.”
Although CPT codes are complex, it’s important for any healthcare practitioner to understand their billing process and avoid the potential for abuse or fraud. Rick finds that our current understanding is limited and can be seen as abuse since, “We don’t know we are doing it wrong.”
Rick outlines multiple ways you can bill to maximize your payments for your treatment sessions but notes that it is important to be ethical. He stresses, “Nobody wants to be on the radar of an insurance company.” And more importantly, “Reputation is everything. It takes a long, long time to develop a positive reputation and it can be gone in a heartbeat.”
For more information on Rick:
Rick Gawenda, PT, is a licensed physical therapist with 25 years of experience and currently serves as the founder and President of Gawenda Seminars & Consulting, Inc. He graduated with a Bachelor of Science degree in Physical Therapy from Wayne State University in Detroit, Michigan, in 1991. Mr. Gawenda is also Director of Finance for Kinetix Advanced Physical Therapy, a private practice with offices located in Southern California. In addition, he previously worked as the Director of Physical Medicine and Rehabilitation at Detroit Receiving Hospital where he was responsible for physical therapy, occupational therapy, and speech-language pathology services, both in the inpatient and outpatient setting.
He has provided valuable education and consulting to hospitals, private practices, skilled nursing facilities, and rehabilitation agencies in the areas of CPT coding, ICD-10 coding, billing, documentation compliance, revenue enhancement, practice management, and denial management as they relate to outpatient therapy services. Mr. Gawenda has presented nationally since 2004 and currently presents approximately 100 dates per year around the United States.
Mr. Gawenda is a member of the American Physical Therapy Association (APTA) and Michigan Physical Therapy Association (MPTA). Mr. Gawenda is the Past President of the Section on Health Policy & Administration of the APTA as well as Past President of the Michigan Association of Medical Rehabilitation Program Administrators.
Mr. Gawenda is also the author of “The How-To Manual for Rehab Documentation: A Complete Guide to Increasing Reimbursement and Reducing Denials” and “Coding and Billing For Outpatient Rehab Made Easy: Proper Use of CPT Codes, ICD-9 Codes and Modifiers”.
Resources discussed on this show:
Episode 175: Making Sense of ICD 10 w/ Rick Gawenda, PT
Darci Lynne: 12-Year-Old Singing Ventriloquist Gets Golden Buzzer – America’s Got Talent 2017
Centers for Medicare and Medicaid Services
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