How do I submit my medical record documentation?
First Coast accepts medical records via:
Is it permissible for a therapist to bill for more than one therapy service that was furnished within the same 15-minute time period?
A therapist may bill for more than one therapy service that was furnished within the same 15-minute time period when "supervised modalities" have been defined by the American Medical Association (AMA) as “untimed and unattended and not requiring the presence of the therapist” (CPT codes 97010 to 97028). One or more supervised modalities may be billed in the same 15-minute time period with any other CPT code, timed or untimed, requiring constant attendance or direct one-on-one patient contact.
The SPOT User Guide: Section 13 - Support
Online help
The footer menu in SPOT offers links to many helpful resources. Refer to Section 11 – Online resources for details on...
Are there any physical therapy services that are considered reimbursable in a comprehensive outpatient rehabilitation facility (CORF) setting but are not considered reimbursable in an outpatient physical therapy (OPT) or rehabilitation agency?
No, however OPTs and CORFs are different provider types and submit claims on different types of bills. In addition, they are not part of an outpatient hospital therapy department.
How do providers prepare documentation for submission?
The Initial Notification Letter includes a documentation checklist to help providers prepare documentation for submission. The documentation checklist can also be found under targeted probe and educate review topics and schedule of review.
Once an ADR is received, a provider should do the following:
How should we code the number of miles for ground or air ambulance trips?
Beginning with dates of service on and after January 1, 2011:
Should a facility use condition code 44 on a claim if the admitting physician decides the patient should be in observation rather than an inpatient setting?
(Additionally, when the physician decides the patient should be in observation without prompting by the utilization review (UR) committee or case management and prior to the discharge of the patient and submission of the claim.)
No. When a physician orders a patient to be placed under observation, the patient's status is outpatient. The purpose of observation is to determine the need for further treatment or for inpatient admission.
What do I do if I have been overpaid because of a duplicate primary payment?
Medicare Secondary Payer (MSP) overpayments are processed differently than non-MSP overpayments and require a refund to be sent within sixty days of receiving a duplicate payment. Complete the appropriate Medicare Secondary Payer return of monies voluntary refund form (see below) and attach a check for the overpaid amount. In addition, the other insurer’s explanation of benefits and/or payment information is required for every claim involved.
What if an MSP refund is not made at the time the provider notifies Medicare of the duplicate primary payment?
Providers are required to pay Medicare within 60 days from the date a payment is received from another payer (primary to Medicare) for the same service for which Medicare paid.
However, if a demand letter is needed by the provider’s accounting department, submit the MSP Overpayment Refund form and the other insurer’s EOB and/or payment information (e.g., a copy of the check) to Medicare.