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Browse PlansRick Gawenda
PT
Rick Gawenda is founder and president of Gawenda Seminars & Consulting, Inc. He graduated in 1991 with a Bachelor of Science in physical therapy from Wayne State University in Detroit. Rick is director of finance for a physical therapist-owned private practice with multiple offices located in Southern California. In addition, he was director of physical medicine and rehabilitation at Detroit Receiving Hospital from February 2003 to December 2009, where he was responsible for physical therapy, occupational therapy, and speech-language pathology services in both the inpatient and outpatient settings. He has provided valuable education and consulting to hospitals, private practices, and rehabilitation agencies in the areas of CPT/ICD-9 coding, billing, documentation compliance, revenue enhancement, and denial management as they relate to outpatient therapy services.
Rick is the past president of the Section on Health Policy & Administration of the American Physical Therapy Association as well as the past president of the Michigan Association of Medical Program Rehabilitation Administrators. He is on the editorial advisory board for Advance for Directors in Rehabilitation. Mr. Gawenda serves as the liaison between the Michigan Physical Therapy Association and National Government Services, which is the Medicare fiscal intermediary for the state of Michigan.
Rick is the author of The How-To Manual for Rehab Documentation: A Complete Guide to Increasing Reimbursement and Reducing Denials and Coding and Billing for Outpatient Rehab Made Easy: Proper Use of CPT Codes, ICD-9 Codes, and Modifiers.
Courses with Rick Gawenda
Browse Course CatalogBilling and NCCI Edits: OT and PT
Presented by Rick Gawenda, PT
Billing and NCCI Edits: OT and PT
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Video Runtime: 65 Minutes; Learning Assessment Time: 19 Minutes
This course will teach participants the National Correct Coding Initiative (NCCI) edits and the use of modifier 59 as they apply to outpatient therapy services. The course will thoroughly explain the Medicare "8-minute rule" and definition of "substantial" per the American Medicare Association for time-based CPT codes. Finally, the course will provide billing scenarios that will teach physical and occupational therapists, physical therapist assistants, and occupational therapy assistants to bill correctly based on the interventions provided and the amount of time each intervention was provided.
Learning Objectives
This course will teach participants the National Correct Coding Initiative (NCCI) edits and the use of modifier 59 as they apply to outpatient therapy services. The course will thoroughly explain the Medicare "8-minute rule" and definition of "substantial" per the American Medicare Association for time-based CPT codes. Finally, the course will provide billing scenarios that will teach physical and occupational therapists, physical therapist assistants, and occupational therapy assistants to bill correctly based on the interventions provided and the amount of time each intervention was provided.
Learning Objectives
- Distinguish which settings NCCI edits apply to and how often they are updated
- Distinguish how one discipline's billing can make another discipline's billing require modifier 59
- Conclude which CPT code requires modifier 59 be appended to it on the claim form
- Execute Medicare's 8-minute rule and definition of "substantial" to bill correctly
- Calculate the correct number of units to bill based on CPT codes provided and amount of time spent providing each code
Billing and NCCI Edits: SLP
Presented by Rick Gawenda, PT
Billing and NCCI Edits: SLP
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and patient education—anytime, anywhere—with video instruction from
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Video Runtime: 49 Minutes; Learning Assessment Time: 22 Minutes
This course will teach participants the National Correct Coding Initiative (NCCI) edits and the use of modifier 59 as they apply to outpatient therapy services. The course will thoroughly explain the Medicare "8-minute rule" and definition of "substantial" per the American Medical Association for time-based CPT codes. Finally, the course will provide billing scenarios that will teach speech-language pathologists to bill correctly based on the interventions provided and the amount of time each intervention was provided.
Learning Objectives
This course will teach participants the National Correct Coding Initiative (NCCI) edits and the use of modifier 59 as they apply to outpatient therapy services. The course will thoroughly explain the Medicare "8-minute rule" and definition of "substantial" per the American Medical Association for time-based CPT codes. Finally, the course will provide billing scenarios that will teach speech-language pathologists to bill correctly based on the interventions provided and the amount of time each intervention was provided.
Learning Objectives
- Distinguish which settings NCCI edits apply to and how often they are updated
- Distinguish how one discipline's billing can make another discipline's billing require modifier 59
- Conclude which CPT code requires modifier 59 be appended to it on the claim form
- Execute Medicare's 8-minute rule and definition of "substantial" to bill correctly
- Calculate the correct number of units to bill based on CPT codes provided and amount of time spent providing each code
Common CPT Codes: SLP
Presented by Rick Gawenda, PT
Common CPT Codes: SLP
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Video Runtime: 70 Minutes; Learning Assessment Time: 45 Minutes
This course will discuss how the monetary value of a CPT code is determined and what the relative value units are that make up the three components of a CPT code. In addition, this course will teach participants the CPT codes most commonly used by speech-language pathologists.
Learning Objectives
This course will discuss how the monetary value of a CPT code is determined and what the relative value units are that make up the three components of a CPT code. In addition, this course will teach participants the CPT codes most commonly used by speech-language pathologists.
Learning Objectives
- Distinguish the three relative value units of a CPT code
- Determine how your geographic region has an impact on payment for each CPT code commonly billed by speech-language pathologists
- Choose between the various evaluation codes commonly billed by speech-language pathologists
- Deduce how a speech-language pathologist may bill more than one evaluation code on the same date of service and/or during the same episode of care
- Determine when a speech-language pathologist would bill for a cognitive assessment or cognitive training
- Prioritize which CPT code to select based on the interventions provided
- Plan how to bill the caregiver training services CPT codes
- Determine the three ways an insurance carrier reimburses for outpatient speech therapy
Common CPT Codes: PT and OT (97110–97763)
Presented by Rick Gawenda, PT
Common CPT Codes: PT and OT (97110–97763)
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Video Runtime: 94 Minutes; Learning Assessment Time: 34 Minutes
This course will teach clinicians how to correctly select the most appropriate CPT code based on the documentation and intent of the intervention. CPT codes discussed in the course will include CPT codes 97110 to 97763. Examples of each CPT code will be provided to better assist the therapist and assistant in selecting the most appropriate CPT code.
Learning Objectives
This course will teach clinicians how to correctly select the most appropriate CPT code based on the documentation and intent of the intervention. CPT codes discussed in the course will include CPT codes 97110 to 97763. Examples of each CPT code will be provided to better assist the therapist and assistant in selecting the most appropriate CPT code.
Learning Objectives
- Identify which CPT codes require one-on-one patient contact
- Determine the difference between group therapy and one-on-one therapy
- List what interventions are included within each CPT code
- Apply how to use the orthotic and prosthetic management and training CPT codes and the L codes for orthotics
- Determine how to bill for wound care services provided in the outpatient therapy setting
- Analyze how to bill the caregiver training services CPT codes
Intro to CPT Codes: PT and OT (Modalities and Miscellaneous)
Presented by Rick Gawenda, PT
Intro to CPT Codes: PT and OT (Modalities and Miscellaneous)
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Video Runtime: 52 Minutes; Learning Assessment Time: 27 Minutes
This course will discuss how the monetary value of a CPT code is determined and what the relative value units are that make up the three components of a CPT code. In addition, this course will teach participants the supervised and constant attendance modality CPT codes, as well as the strapping, range-of-motion testing, canalith repositioning, dry needling, and biofeedback for pelvic health CPT codes used by physical and occupational therapists, physical therapist assistants, and occupational therapy assistants.
Learning Objectives
This course will discuss how the monetary value of a CPT code is determined and what the relative value units are that make up the three components of a CPT code. In addition, this course will teach participants the supervised and constant attendance modality CPT codes, as well as the strapping, range-of-motion testing, canalith repositioning, dry needling, and biofeedback for pelvic health CPT codes used by physical and occupational therapists, physical therapist assistants, and occupational therapy assistants.
Learning Objectives
- List the three relative value units of a CPT code
- Calculate how your geographic region has an impact on your payment for each CPT code
- Examine which modality CPT codes require supervision versus constant attendance
- Determine the difference between strapping and kinesiotaping
- Determine when you can bill for canalith repositioning
- Analyze three ways that an insurance carrier reimburses for outpatient therapy services
Remote Therapeutic Monitoring for Outpatient Physical and Occupational Therapy
Presented by Rick Gawenda, PT
Remote Therapeutic Monitoring for Outpatient Physical and Occupational Therapy
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Video Runtime: 82 Minutes; Learning Assessment Time: 29 Minutes
This course will thoroughly explain the six remote therapeutic monitoring (RTM) CPT codes, including defining what a medical device is and how and when you can bill for each CPT code, and what you should document to support the billing of each CPT code. Case scenarios will be presented to assist participants in determining how the RTM codes can be utilized and billed correctly. The course will also provide three models of RTM implementation and will discuss the pros and possible cons for each of the three models.
Learning Objectives
This course will thoroughly explain the six remote therapeutic monitoring (RTM) CPT codes, including defining what a medical device is and how and when you can bill for each CPT code, and what you should document to support the billing of each CPT code. Case scenarios will be presented to assist participants in determining how the RTM codes can be utilized and billed correctly. The course will also provide three models of RTM implementation and will discuss the pros and possible cons for each of the three models.
Learning Objectives
- Distinguish the description of each of the six RTM codes
- Select what type of device(s) must be used in order to bill CPT codes 98975-98978
- Determine what you should document to support the billing of each RTM CPT code
- Apply supervision requirements when RTM is provided by a therapist/therapy assistant
- Determine the frequency of billing each of the RTM CPT codes
- Select which CPT codes the de minimis standard and MPPR apply to
- Determine which RTM model is best for your practice or organization
Documentation for Evaluations and Re-Evaluations
Presented by Rick Gawenda, PT
Documentation for Evaluations and Re-Evaluations
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This course will teach participants the required elements regarding documentation for evaluations and re-evaluations. The course will focus on the importance of the subjective intake and objective examination during the initial evaluation that will establish the need for continued therapy services. The course will teach participants the four questions a goal should answer and provide examples of function-based goals. Finally, the course will discuss when a re-evaluation is appropriate to perform and bill and what must be documented to support the billing of a re-evaluation to an insurance carrier.
Therapy Cap, ABN, and Multiple Procedure Payment Reduction Policy
Presented by Rick Gawenda, PT
Therapy Cap, ABN, and Multiple Procedure Payment Reduction Policy
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This course will teach the participants the current status of the therapy cap, therapy cap exception process, and what is occurring with claims that exceed $3,700 in a calendar year. This course will discuss when it is and is not appropriate to issue an advance beneficiary notice of noncoverage (ABN) to a Medicare beneficiary receiving outpatient therapy services. The course will discuss routine use of the ABN and provide completed examples of the ABN for outpatient therapy services.
This course will explain the MPPR and its implication on payment for your services and your bottom line profit margin. Case scenarios will be used to show participants how therapists are paid a lower rate once they bill more than one unit of any modality or intervention on the same day. Case scenarios will also teach participants how their payment is reduced when a Medicare beneficiary is seen by two or all three disciplines on the same date of service.
Documentation: Everything After the Evaluation Until Discharge
Presented by Rick Gawenda, PT
Documentation: Everything After the Evaluation Until Discharge
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This course will teach participants the required elements for a progress report, daily note, discharge report, and Medicare Part B certifications and recertifications. While completing this course, participants will learn how a progress report should support the therapy already provided and why continued therapy is necessary. The course will teach participants how to document in the daily note to support the services required the skills of a therapist to provide and the CPT codes that were billed that date of service. The course will discuss the importance of a discharge report and what insurance carriers require a discharge report. Finally, the course will discuss the Medicare Part B certification and recertification requirements.
Understanding PT Evaluation Codes: Case Scenarios
Presented by Rick Gawenda, PT
Understanding PT Evaluation Codes: Case Scenarios
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This course will teach participants the four components that must be met and documented in the medical record to report the appropriate physical therapy evaluation complexity level. The course will teach participants how patient personal factors and/or comorbidities may impact the physical therapy plan of care. The course will provide examples of evolving and changing characteristics and unstable and unpredictable characteristics that will enable the physical therapist in selecting the appropriate clinical presentation level. Finally, this course will use case scenario's in orthopedics, pediatrics, and neurology to teach participants how to determine the appropriate complexity level and the documentation that must be present in the medical record to support their choice.
Understanding OT Evaluation Codes: Case Scenarios
Presented by Rick Gawenda, PT
Understanding OT Evaluation Codes: Case Scenarios
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This course will teach participants the three components that must be met and documented in the medical record to report the appropriate occupational therapy evaluation complexity level. The course will teach participants how patient comorbidities may impact occupational performance. The course will teach participants the importance of documenting the amount of assistance and/or modification that the occupational therapist provides during the initial evaluation in order for the patient to complete the task. Finally, this course will use case scenarios in orthopedics, pediatrics and neurology to teach participants how to determine the appropriate complexity level and the documentation that must be present in the medical record to support their choice.
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Sign Up for FreeWebinars with Rick Gawenda
May 21, 2020
Providing and Billing Outpatient Telehealth Therapy Services
Presented by Rick Gawenda
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Apr 10, 2020
Updates on E-Visits and Telehealth for Outpatient Therapy Services: Part 2
Presented by Nancy Beckley and Rick Gawenda
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Mar 31, 2020
Updates on E-Visits and Telehealth for Outpatient Therapy Services, Part 1
Presented by Nancy Beckley and Rick Gawenda
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Jan 17, 2019
Navigating MIPS for Physical and Occupational Therapy in 2019
Presented by Rick Gawenda
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