This is one of those Coaching Updates I love to write for my attorney friends who hire people as you assist providers to manage denials and fight during litigation. Michigan’s Personal Injury Protection (PIP) system offers a unique opportunity for rehabilitation providers to deliver essential services to auto accident victims. Untimed codes, often referred to as service-based codes, are pivotal in this context. These codes are billed once per session, irrespective of the session’s duration, and are commonly used in speech-language pathology, physical therapy, and occupational therapy.
Commonly Used Untimed Codes in Rehabilitation:
- Speech Therapy:
- 92507: Treatment of speech, language, voice, communication, and/or auditory processing disorder (individual)
- 92508: Group speech therapy
- 92521–92524: Evaluations for speech fluency, speech production, speech sound language comprehension, and behavioral quality analysis of voice
- Physical & Occupational Therapy:
- 97161–97163: Physical therapy evaluations (low to high complexity)
- 97165–97167: Occupational therapy evaluations (low to high complexity)
- 97012: Mechanical traction therapy
- 97022: Whirlpool therapy
- 97035: Ultrasound therapy
These codes are billed once per patient per day, regardless of the time spent during the session.
Preparing Internally for Effective Use
1. Documentation: Ensure that session notes comprehensively detail the services provided, patient response, and clinical justifications. Accurate documentation supports the medical necessity of services and facilitates smoother billing processes
2. Staff Training: Educate your clinical and billing staff on the nuances of untimed codes, emphasizing the importance of consistent documentation and understanding payer-specific requirements.
3. Billing Systems: Utilize billing software that can accurately handle untimed codes, ensuring that each code is billed appropriately per session.
Calculating Operational Costs:
When determining the cost of services associated with untimed codes, consider the following:
- Staff Salaries: Wages for therapists, administrative, and support staff.
- Overhead: Rent, utilities, equipment depreciation, and other facility-related expenses.
- Supplies: Therapeutic materials and consumables used during sessions.
- Administrative Costs: Billing, scheduling, and record-keeping expenses.
By aggregating these costs, you can establish a baseline for your service rates, ensuring sustainability and profitability.
Anticipating Discount Ranges:
In negotiations with insurers, it’s common to encounter requests for discounts. Typically, providers should be prepared for discount ranges between 10% to 25% off their standard rates. However, it’s crucial to ensure that any agreed-upon rates cover your operational costs and provide a reasonable margin.
Responding to Insurer Deductions Beyond Norms:
If an insurer applies deductions that exceed typical market norms or Medicare comparisons:
- Review the Explanation of Benefits (EOB): Understand the rationale behind the deduction.
- Prepare a Detailed Appeal: Include comprehensive documentation of services rendered, justifications for the charges, and comparisons to standard rates.
- Engage in Direct Communication: Reach out to the insurer’s provider relations department to discuss and resolve discrepancies
- Seek Professional Guidance: Consider consulting with billing experts or legal counsel to navigate complex disputes.
My Summary and Conclusion…
Effectively utilizing untimed codes within Michigan’s PIP system requires meticulous preparation, accurate documentation, and proactive communication with insurers. By understanding the intricacies of these codes and implementing robust internal processes, providers can ensure compliance, optimize reimbursements, and continue delivering high-quality care to patients.
For further assistance or inquiries, please contact our Audit Division at Direct Care Training & Resource Center, Inc. or Electronic Medical Services, LLC.
Sincerely,
Bruce W. McCollum, MHA
Audit Division
Direct Care Training & Resource Center, Inc.
Electronic Medical Services, LLC
audit@directcaretraining.com
Another Blog Post by Direct Care Training & Resource Center, Inc. Photos used are designed to complement the written content. They do not imply a relationship with or endorsement by any individual nor entity and may belong to their respective copyright holders.
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