Identifying charge capture opportunities in outpatient rehabilitation
Outpatient physical and occupational therapy are paid in one of two ways: on a fixed fee schedule, or as a percent of charges. An organization can miss on net revenue opportunities when billing for a percent of charges – especially if documentation is not accurate. That’s why it’s critical that your team creates an effective charge capture program. To do this, rehabilitation leaders must understand all outpatient therapy charge opportunities.
Opportunity 1: Medicare’s 8-minute rule
The Medicare 8-minute rule states that a therapist must provide eight minutes of treatment directly to a patient for a time-based code to receive reimbursement from Medicare. It is important to remember that there is a difference between timed codes and service codes.
The 8-minute rule has created an unintended pattern of providers undercharging for their services. That’s because the rule is difficult to understand, and clinicians would often rather bill less than risk a denial.
Opportunity 2: Non-Medicare billing options
Most insurance companies do not require the use of the 8-minute rule to determine charges for their insured individuals. In fact, many insurance companies’ billing manuals do not have any input on charge capture methodology, meaning there is an opportunity to increase your net revenue.
One charge capture opportunity that outpatient providers should consider as an opportunity to increase their net revenue is the substantial portion methodology. This methodology is backed by CPT Assistant and does not have the same requirements as the Medicare 8-minute rule. In some cases, the SPM results in a higher-level charge capture.
Interested in learning more?
If you’re interested in learning more about charge capture in outpatient rehabilitation, we encourage you to watch our on-demand webinar: A patient-centric way to grow revenue in hospital outpatient therapy¸ or download the FAQs from the live webinar.
How WellSky can help
WellSky Rehabilitation is purpose-built for outpatient rehabilitation providers. Our solution can be configured to capture charges in a variety of ways ensuring your team stays compliant with payer requests while helping you optimize revenue. Learn more by contacting a WellSky Rehabilitation expert today!
About the author
John Britt is a senior manager with Blue & Co., LLC. John has delivered critical consulting support to leadership and management teams across the country, and he has a passion for helping his clients achieve optimal, sustainable results in the areas of revenue cycle, operational efficiency, and organizational alignment. John has experience helping small hospitals and large-scale health systems.
John has a background in managing hospital-based rehabilitation services and was the COO of a therapy firm that provided therapy services to multiple hospitals and physicians’ offices. This experience has propelled John to guide over 500 hospitals to improve patient access, patient satisfaction, and financial outcomes.