Billing Repetitive Services March 7, 2013 Karen Kroupa, Outreach Analyst Agenda Defining Repetitive Services Billing Repetitive Services Leave of Absence Non-Repetitive-Services Billing Recurring Services Repetitive Services Defined Services furnished by a single provider (same provider number; PTAN) To a single beneficiary Over a span of time Monthly increments At conclusion of treatment Billed with one of the following revenue code: Type of Service Revenue Codes Durable Medical Equipment (DME) Rental 290-299 Respiratory Therapy 410, 412, 419 Physical Therapy 420-429 Occupation Therapy 430-439 Speech-Language Pathology 440-449 Skilled Nursing 550-559 Kidney Dialysis Treatments 820-859 Cardiac Rehab Services 482, 943 Pulmonary Rehab Services 948 Updated 02/15/2013 1 http://www.wpsmedicare.com/
Consolidating these repetitive services reduces CMS processing cost, creating savings for the Medicare trust fund! Billing Repetitive Services Monthly claims Include all repetitive services Any item and /or service needed to perform the repetitive service Even if not on the repetitive service list Examples: disposable supplies, drugs or equipment used to furnish a repetitive service Therapy services Multiple types of therapy services from the same revenue center can be billed together Report doctor s Unique Physician Identification Number (UPIN) If other physicians order more than one therapy, enter the additional physician UPINs in the assisting physician UPIN fields Leave of Absence Inpatient stay, outpatient surgery or outpatient OPPS services occurring during repetitive services date span Submit one monthly bill for repetitive services Append the 74 occurrence span code on the monthly repetitive services claim Encompass entire inpatient stay, outpatient surgery or outpatient services Common Working File (CWF) and FISS system recognize that occurrence span code 74 indicates beneficiary is on a leave of absence from repetitive services for those dates Beneficiary cannot receive repetitive services at the same time as a leave of absence service No overlap error will occur Page 2 of 5
Leave of Absence Carve Out Example Monthly Repetitive Claim Statement Covers Period From Through 02/01/13 02/28/13 Inpatient Claim Occurrence Span Code From Through 74 02/12/13 02/16/13 Statement Covers Period From Through 02/12/13 02/16/13 Line Item Service Dates 1) 02/04/13 2) 02/11/13 3) 4) 02/25/13 Non-Repetitive Services Revenue code not on the list of repetitive services A non-repetitive, one time service performed on same day as a repetitive service Report non-repetitive OPPS service(s) on a separate OPPS claim Include any packaged and/or services related to the non-repetitive services Example: outpatient consultation and CT scan performed on same day as a physical therapy visit. Use only actual service dates Page 3 of 5
Repetitive and Non-Repetitive Services Example Monthly Repetitive Claim Line Item Service Date 02/04/13 02/11/13 1. Physical Therapy 2. Outpatient Consultation 3. CT Scan Outpatient Claim Line Item Service Date Submitting Recurring Services Revenue code not on list of Repetitive Services Services typically involving multiple encounters e. g. Chemotherapy, Radiation therapy May be billed on a single claim, or One separate claim for each encounter Billing Recurring Services Examples 02/01/13 02/08/13 02/22/13 Submit multiple claims for each date of service (include only the recurring service and its related services) 02/29/13 OR Page 4 of 5
Submit a monthly claim for all line item dates of service (for the entire month s recurring services with all services related to the recurring services) 02/01/13 02/08/13 02/22/13 02/29/13 References CMS Internet-Only Manuals (IOM), Publication 100-04 Medicare Claims Processing Manual, Chapter 1, Section 50.2.2 http://www.cms.gov/regulations-and-guidance/guidance/manuals/downloads/clm104c01.pdf Page 5 of 5