Practice Management

OMT Reimbursement

The AAO Board of Trustees created the Osteopathic Medical Economics Committee as an informational resource for members dealing with difficulties regarding coding reimbursement for osteopathic manipulative treatment (OMT). The committee also reviews documents and audiovisual materials pertaining to medical economics issues, which can be used to influence coverage and reimbursement policies of third-party carriers and legislators alike. The committee serves as a resource for members, insurance companies and attorneys who need access to osteopathic manipulative medicine experts for medical opinions, depositions and court testimony.

In addition, the American Osteopathic Association has many valuable resources for physicians in practice, including HIPAA guidance, billing and coding information, ICD-10 FAQs, a Medicare enrollment guide and advice for physicians who are starting, selling or closing a practice

Other resources

www.ama-assn.org (click on “professional resources”)
www.cms.hhs.gov/

Accurate coding is a skill learned to maximize reimbursement. Requirements of Current Procedural Terminology (CPT) and the Centers for Medicare and Medicaid Services (CMS) are accepted throughout the United States, but Medicare contractors and insurers may have varying interpretations of some of the requirements.

Definitions:

New patient: a patient who has not received care from you or members of your group in any service location in the past 3 years. Therefore, if an established patient has not received care from you or your group in the past 3 years, patient can be billed as a new patient.

Group Practice: physicians belonging to the same Medicare billing group identification in the same specialty.

What are the Criteria for E&M Visits?

History

  • Chief complaint (CC)
  • History of Present Illness (HPI)
  • Review of Systems
  • Past History, Family History, Social History

Other important information to help with grading your medical decision-making should include: Source of Information, e.g., patient, chart or other; miscellaneous information important to physicians, e.g., allergies, prior infectious diseases.

Exam: number of organ systems

Medical Decision Making (MDM)

  • List of diagnosis and management provided
  • Studies reviewed and new studies ordered if needed
  • Complexity (straightforward, moderate, high)
  • Risk level to patient
  • Time spent Counseling, etc.

To establish how many systems are needed to determine a level of billing, please refer to www.cms.hhs.gov, www.acofp.org.

Acceptable Tips on Documentation:

  • All other review of systems are negative.
  • Family history unchanged since last visit or give a date.

List of CPT Codes:

  • New office codes: 9920L-99205
  • Established office codes: 992L1-99215
  • Initial hospital consultation codes: 99251-99254
  • Follow-up hospital consultation codes: 9923L-99233
  • Outpatient office consultation codes: 9934L-99245

If you have any questions regarding physician services, billing and coding, reimbursement or practice-related issues, email us at info@academyofosteopathy.org.

News

New Ideas Forum 2019

AAO members who submit the most promising proposals for advancing osteopathic manipulative medicine will be given 15 to 30 minutes to outline their thoughts, demonstrate their techniques and field questions from their peers.

Giving Tuesday Is Nov. 27

Help AAO knock out its fundraising goal on Tuesday, Nov. 27. First established in 2012, Giving Tuesday encourages people to prioritize charitable giving during the busy holiday shopping season.

AAO Recognized for Contributions to Profession

On Saturday, July 21, the AAO was one of four recipients of the American Osteopathic Association’s 2019 STARs (Strategic Team Award and Recognition) for its dedication to advancing osteopathic medicine. The STARs recognize contributions made by state, specialty and regional affiliates, colleges of osteopathic medicine, osteopathic postdoctoral training institutions (OPTIs), and nonpractice affiliates that have advanced the osteopathic profession. The award honors programs and activities that align with the initiatives in the AOA’s strategic plan.