Occupational Therapy and the Alternative Payment Model

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Occupational Therapy and the Alternative Payment Model

Although the introduction of payment models in healthcare has shaken up occupational therapy, it’s essential to remember that OT still plays an integral role. Although PDPM and PDGM have drastically altered therapy, as an OT professional you have several tools at your disposal to help navigate these new systems and guarantee you provide your patients with the highest quality care.

Occupational therapists will need to adjust their billing and documentation processes, including altering their approach to co-treatment and recording the total time spent on each service accurately and precisely. Additionally, the Centers for Medicare & Medicaid Services (CMS) has proposed significant CPT code reductions which could impact reimbursement. Thankfully, APTA, AOTA, and ASHA have been actively advocating that Congress and CMS pay attention to OT and PT practitioners’ concerns.

Therapists should review the CPT codes they currently use and confirm they comply with CPT guidelines and are appropriate for the patient population they serve. Furthermore, make sure the codes align with APTA’s RVU calculations.

Another essential step therapists should take is making sure they utilize the correct number of timed codes. This is important since these codes track patient length of stay in therapy and should be billed correctly.

For instance, if a member receives 60 minutes of therapy, the provider should report 4 units of code 97530. Conversely, if the member receives an overall total of 80 minutes of therapy, 10 units would be reported under code 97530.

In certain instances, therapists may opt to bill for multiple timed codes per session as long as they document the number of units used for each service. Doing this can be an efficient way to reduce paperwork that must be submitted and processed.

Many therapists have begun incorporating group therapy into their practices, which can be an effective way for patients to reduce the cost of care. This is especially helpful for those with limited resources and on sliding fee schedules.

Finally, therapists interested in participating in an APM should be sure to comprehend the requirements and process for qualifying. Furthermore, they should weigh their personal objectives against the costs of implementing an APM before signing a contract.

Having the correct strategy can make a significant impact on how you manage your business and offer services. It also gives you an opportunity to focus on what strengths you already possess while expanding upon those areas that require improvement.

An effective strategy can ultimately save your business money in the long run by helping to reduce unnecessary claims and avoid rebilling penalties. A sound practice management plan will enable you to control overhead while keeping patients satisfied and providing top notch services. Furthermore, having a sound strategy also allows for partnership development with payers for quality healthcare at fair prices.

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- Welcome, SoundTherapy.com lowers anxiety 86%, pain 77%, and boosts memory 11-29%. Click on the brain to sign up or share with buttons below to help others: