Getting Paid for Outpatient Therapy Services: Documentation, Coding, and Billing

Saturday, September 15th, 2018- Stockton University

Main Campus Room L-112 8:00 a.m.-4:00 p.m., Registration begins at 7:30 a.m.

Course Description

Physical, occupational and speech therapy services continue to be on the audit radar for various Medicare and private insurance carriers medical review entities for documentation, coding and billing issues. This seminar will teach participants the necessary components of documentation for the initial evaluation, reevaluation, progress reports, daily notes, discharge reports and the Medicare Part B certification and recertification process that will help participants document the key points in supporting medical necessity and the skilled nature of outpatient therapy services.

The seminar will teach participants the correct use of CPT codes for modalities and interventions used by physical therapists, physical therapist assistants, occupational therapists, occupational therapy assistants and speech-language pathologists in all outpatient settings. The seminar will teach participants the National Correct Coding Initiative (NCCI) edits, the application of modifier 59 and how one discipline’s billing can cause another discipline’s billing to require modifier 59. Finally, the seminar will discuss Medicare’s “8-minute rule”, definition of substantial per the American Medical Association, and provide billing scenario’s to ensure therapists bill correctly to all insurance carriers.

Learning Objectives

  1. Describe and implement the necessary components of an initial evaluation to support the need for skilled therapy services
  2. Identify when a reevaluation is appropriate to perform on a patient and bill to an insurance carrier
  3. Describe and implement the necessary components of a progress report to support the therapy already provided and the need for continued skilled therapy services
  4. Apply strategies to more effectively support medical necessity and skilled services in your daily notes
  5. Describe and implement the necessary components of a discharge report to
    demonstrate the nature of skilled services provided to support why you should be paid for those services
  6. Understand the certification and recertification process for Medicare Part B therapy services
  7. Define and distinguish between column 1/column 2 NCCI edits
  8. Understand which CPT code(s) require modifier 59 be appended to them on the claim form
  9. Describe & understand how to select the correct CPT code(s) based on interventions provided and documentation in the medical record
  10. Be able to charge correctly for the services you provide under outpatient therapy benefits for Medicare and private insurance carriers

Instructor: Rick Gawenda, PT


Speech Language PathologistsOccupational Therapists, Occupational Therapist Assistants, Physical Therapists, Physical Therapist Assistants


Continuing Education Credit Information

AOTA: This program is approved for .65 CEUs (Intermediate level); (6.5 contact hours).

ASHA: This program is offered for .65 ASHA CEUs (Intermediate level; Related area).

NJBPTE: This program has been approved by the NJBPTE for 6.5 continuing education credits Approval #1806-59

Approved Provider of Continuing Education by the American Occupational Therapy Association, Inc.

Stockton University is an AOTA Approved Provider of continuing education.

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Cost: $229.99


Or please complete the registration form and return it to the School of Health Sciences by email, fax, or mail.


Rick Gawenda, PT Owner/President of Gawenda Semininars and Consulting

  • Financial: Rick Gawenda will receive an honorarium for this speaking engagement from Bacharach Institute of Rehabilitation. 
  • Non Financial: Rick Gawenda has no non-financial relationships to disclose
    The seminar will focus on the consulting to medical professionals in the areas of documentation, coding, and billing


Stockton University

101 Vera King Farris Drive

Galloway, NJ 08205  L-112

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