2.a Overview

Note: Do not implement the steps outlined in this section until it is clear that the therapy limits will be implemented and all therapy charges with service dates prior to January 1, 2006 have been posted.

Abstract. Effective January 1, 2006 the limits that were in effect during 1999 and part of 2003 have been reinstated. These are limits that effect the amounts that can be billed to Medicare Part ‘B’ (for non-Medicare Part A residents). These limits are $1,740 per calendar year for Physical Therapy (PT) & Speech Therapy (SP) combined, and $1,740 per calendar year for Occupational Therapy (OT). The following programs have been modified to reflect these changes. Please note that a $1,740 limit translates to $1,392 of billings ($1,740 less 20% co-insurance).

The software assumes that Part B charges are only written off after the limits are exceeded. If you are currently writing off all Part B charges, your tables must be changed not to write off those charges until the limits are exceeded. After the billing has been sent to Medicare, a program can be run to write off the Part B charges that were posted [Write Off Part B Ancillaries ‘WOPARTB’ - System, 14, 8].

UB92INFO Update - UB92 Billing Information - [GM, 8, 2, 7]

This program can be used to display the PT, OT limits. These limits are automatically tracked by the system and can be viewed on the following screen:  

Please note: The totals for the amounts previously billed for PT, OT and Speech as accumulated in the UB92INFO program were reset to zero upon loading this release. These totals will not be affected by any posting of charges with service dates before January 1, 2006.

POSTANCL - Post Ancillary Charges - [GM, 8, 2, ,2]

This program can be used, as in the past, to post ancillary charges. When posting PT, OT, or ST charges the system tracks the cumulative amount charged (see above). If the HCFA limits are exceeded, the amount over the HCFA limit is automatically written off.

Example (see screen above):

• Amount previously billed for PT is $1,640

• If the current therapy charge is $150, only $80 will be billed:

• ($1,740 limit minus $1,640 already billed, less 20% co-insurance)  

2.b Resident Report Generator, PMGEN - fields for PT and OT Amounts Used

The Part B PT and OT amounts that were already billed for each resident can be viewed with the Resident Master report generator  using the following fields:

• X14 - PT amount used

• X15 - OT amount used

This information can also be seen in the UB92INFO program described on the previous page.  

2.c Verify that your Part B charges are NOT written off.

For Part B billing only.

Creating an Ancillary Billing Type Table File record:

ANCILLARIES BILL TABLE     Enter Main Key : PB                    Secondary Key: PART B     Description    : MEDICARE PART B            Bill     Receive  Send Bill  & Send Bill  Contractual Allow   Write Off If      Type      From      to      to Receivable  Write Off          In Elig Part B     Medicaid   S___     PB__           N             N                 Y     Medicare   S___     NB__           N             Y                 N     Private    S___     PB__           N             N                 N     VA         S___     PB__           N             N                 N     Other      S___     PB__           N             N                 N       Bedhold    S___     NB__           N             Y                 N                                                     *PB = Part B                                                  **C  = Co Insurance Provider       Enter (F) To File (I) To Ignore:  F

Verify that your Part B charges are NOT written off (cont.).

Modify your ancillary table file:

ANCILLARY TABLE CODE MAINTENANCE       Main Key: 420    Secondary Key: PT_______  Description: PT VISIT____________     Classification: 00         RVU: .00__      Bill form (1/2): 1  Min _> Trt: ___   Anc. Bill Type: PB         Condition: __   HCPCS Code     : _______   Svc. Type Ind.: __                                Modifier: ______    Ancil. Basis:  T      GL Account No.: .0000____    T _ Treatment         Billing Revenue Code: 420      Ancillary Type:  N    D_Day V_Visit         Co_Ins.Ancillary#:  999       (I)_Included in Rate        Current           Diagnosis code   : ______     (N)_not in rate  (P)_Pvt    Charge *Supplier      Bill Bedhold(Y/N): _          Doctor: ___    25.00___   ___        Equip Cost (or Non Covered Daily Rate) Current: _______           _  Prior  _                                           Prior  : _______     rate    dates    Supplier   Service Type     UB92       Writeoff Percent    ______  ________    ___      Part A : __    Part A : Y   Immediate: .00   7    ______  ________    ___      Hicfa  : __    Part B : Y   Co_Insur.: 20.00 7    For Demo Project (Pseudo Charge) _ Based on Visits/Costed Requisition(V/C): V                (e.g., For PT,OT,ST use 'V', For Pharmacy,Supplies use 'C')    Enter (F) to File (I) to Ignore:   F

  4.   

4.	At Main Key type the first ancillary to be changed (or press PF 2) and press ENTER.
5.	At Anc. Bill Type type PB
6.	At Write-off Immediate type 0
	At Co-insurance type 20.00
7.	Press ENTER.
8.	Repeat from step 4 for each revenue type ancillary.

2.d Entering the HCPCS Rates for 2006.

The rates for all PT, OT and Speech HCPCS codes must be accurate for 2006 for the limits to work properly.

Modify your ancillary table file: