Medicare PTA/COTA Modifiers

With the looming PTA/COTA differential Medicare is requiring that when a PTA/COTA perform a service line for a Medicare patient that either a CQ or CO modifier is added for visits after January 1st 2020.  The APTA has written a nice article summarizing the new rule.  

Heno has added a checkbox that can be enabled for Medicare insurance companies.  With the December, 15 2019 release we will auto add a rule to all insurance companies that currently have the "Prompt for Progress Note at 10 Visits" already turned on.

1. To turn manage these rules go to to Billing -> Insurance -> Rules

There are 2 Options

A. "PTA/COTA Differential - Show" - If this option is selected it will show a Radio Box that allows the user entering the charges to choose PTA, COTA, or No.  If they choose PTA/COTA it will automatically apply the corresponding Modifier to that line.

B. "PTA/COTA Differential - Prompt" - Same as option A but, will include a "No & Silence Prompt" option if the user does NOT choose the PTA/COTA option and does NOT choose the "No & Silence Prompt" option then, when "Ready for Checkout" or, "Checkout" is clicked it will present a Checkbox to confirm that a PTA/COTA was not involved in this treatment.  Once the box is checked it will not prompt again for the life of this appointment

2. If the visit is prior to Jan 1, 2020 the PTA/COTA prompt will display but, will be read-only and not prompt for visits that have the rules applied.