Billing pressure

Photo by Art Institute of Chicago on Unsplash

This is yet another reason for you to try and stay reasonably healthy, and educate yourself on your options.

There are some dirty little secrets in our field, and I’m going to expose another one, billing pressure, similar to peer pressure in teens.

Most or all rehab people who can bill for services have experienced this in our careers. Most facilities expect us to bill for as many services as possible.

That’s fine, if it’s warranted. The grey area is when we are expected to extend out timed visits, and bill for more time than is needed.

Billing units

Years ago, Medicare came out with this 8 minute minimum billing rule. There have been several changes over the years. At one point we were supposed to hold a stopwatch, and stop billing time if a patient had to rest. That was tedious and ridiculous.

All of us have been trained, and know these minimum timed billable units; 8, 23, 38, etc. That’s just the minimum per intervention. Most of my career I was expected to bill for an entire hour, whether that was needed or not.

Photo by Jp Valery on Unsplash

Once these rules were in place, people starting treating to match billing times and codes, instead of what was actually needed for the patient. That’s a common theme in the industry. Hey, we’re gonna reimburse more for covid. Guess what? Everyone “tests positive.”

What a coincidence that someone received an ultrasound for exactly 8 minutes? What are the chances?

I discuss more issues in this article;

Sorry Jimmy Dore, Medicare For All will not work

Age and experience

When I was younger and had just started my career, I didn’t know how to question this, push back, or just refuse, especially without fear or anger. Younger graduates are much easier to manipulate.

When I eventually owned my own clinic, one of the benefits was a lack of that billing pressure. If I saw someone who clearly did not need to be seen for an entire hour, we just billed what was appropriate.

Unfortunately, that is also extremely naive, as billing vs insurance claims is a game that the big insurance scams want you to lose at.

Hot and cold packs

I’ve always hated billing people for hot or cold packs. Just sitting there, wearing a cold pack? You could do that at home. I do like to show people what it might offer them in the way of pain relief, once. Or ideally they are lying on a hot pack while performing the exercises, which is ultimately what is going to help the most.

If you don’t want to be billed for something, speak up. You have to right to refuse any treatment. We’ve forgotten that the last 4 years, but it has always been that way. Just say you will ice at home.

The flip side to that, is some people just want massage and no exercises. That’s not what we do. You can see a massage therapist for that. We are “physical” therapy. The focus is exercises. Massage is generally only used for 10 minutes to make the exercises more tolerable.

Protect your body, and protect your wallet.