Question:

Can you provide some general guidelines for getting correct payment for RT?

Answer:

Receiving correct reimbursement while maintaining regulatory compliance for respiratory therapy and pulmonary function studies requires adherence to the following concepts:

• Complete documentation of services rendered and their medical necessity
• Accurate code assignment
• Valid charge-capture procedures
• Logical fee structures
• Efficient data-collection and information regarding processes
• Effective billing and reporting procedures.

The payment that hospitals receive from third-party payers for an outpatient service depends on codes and related charges recorded on the claim form. Two types of codes dominate: CPT/HCPCS codes and revenue codes. The CPT/HCPCS procedure/ service codes are part of the CMS coding system. The revenue codes are prescribed by CMS to identify the facility’s cost classification of the product or service.

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Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

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