Billing for Pediatric Therapy and ADOS Testing

Pediatric Therapy and ADOS Testing

Billing for Pediatric Therapy and ADOS Testing – There is so much diagnostic and standardized testing that goes into pediatric therapy. It requires a lot of documentation and time that is integral to creating a successful care plan for a patient. A common question that arises from clinic owners and providers of pediatric therapy is about ADOS (Autism Diagnostic Observation Schedule) testing and whether speech therapists can be paid for the screening and documentation around it.

Please note that this article is focusing on ADOS testing if you feel you or a speech therapist employed by you is capable of doing the test and making that diagnosis. This article is not insisting that ADOS testing is appropriate to be done by every office or every situation. ASHA’s official stance is below.

Speech-language pathologists who acquire and maintain the necessary knowledge and skills can diagnose ASD, typically as part of a diagnostic team or in other multidisciplinary collaborations, and the process of diagnosis should include appropriate referrals to rule out other conditions and facilitate access to comprehensive services.

There is no specific procedure code for ADOS testing. Instead, ADOS testing falls under two developmental testing codes.

96112: Developmental test administration (including assessment of fine and/or gross motor, language, cognitive level, social, memory and/or executive functions by standardized developmental instruments when performed), by physician or other qualified health care professional, with interpretation and report; first hour

96113: Each additional 30 minutes, should your testing exceed 1 hour

These codes cover both the actual test administration andthe reporting and interpretation that follows the test. You’ll want to be sure that you track your time spent both with the patient and working on the report afterward as they are both reimbursable.

Before billing these services you’ll want to ensure they are included in your fee schedule with any insurances you are in network with. Please note that these codes are not covered under the pediatric therapy fee schedule for Florida Medicaid and Florida Medicaid may require any diagnosis to be PCP-driven.

How To Find The Right Billing Agency For Your Therapy Practice

How To Find the Right Billing Agency - Edwards Electronic Processing Blog

As a therapy billing agency with over 25 years of experience, we understand that billing can be complex, intimidating, and confusing. It is also perhaps the most important function you have to perform as a practice owner; after all, accurate and timely billing is at the core of a thriving practice.

Even if you’ve decided that you need outside help with all tasks related to billing, choosing a trustworthy agency is not a straightforward task. Below, we share our master tips for choosing a billing agency. Read on to get the scoop.

  1. Meet face-to-face. Before you decide to trust anyone with the enormous responsibility of collecting your revenue, it’s best to get a feel for them in person. There is no substitute for face-to-face interaction. It can tell you more than any phone call or online search will. Once you’ve narrowed down your choices, we suggest setting up a time to meet with your potential billers and make final decisions based on how those meetings unfold.
  2. Listen for a high level of industry knowledge. From the first interaction, your communications with an agency should feel right, especially when it comes to industry verbiage. When someone is at ease with the lingo you use every day, including insurance terminology and CPT codes for each discipline, it is a sign that they have a good understanding of the nuances that accurate billing processes require.
  3. Look for an emphasis on great customer service. Any time you have a question or concern, you should feel comfortable calling up your billers and asking them anything. This kind of open relationship is of utmost importance. A billing agency that is willing to go the proverbial extra mile for you is one that will fight for you.
  4. Take note of additional services. While billing agencies focus on properly submitting claims and posting payments for you, some agencies offer services outside of the basics. These can include eligibility verification, authorization requests, and continuous maintenance of aging claims. It’s essential to understand the full range of what you’re getting when you begin a relationship with an agency.
  5. Understand the scope of provider types the agency services. More is not always better. You should select an agency that services therapy providers. Just because a billing agency services cardiologists or chiropractors, for instance, does not mean they can service you. Therapy billing is unique.

We’re confident that following the above recommendations will lead you to the right fit. How do we know? Find out more about what EEP offers, above and beyond the accuracy and integrity you should expect from a therapy billing agency.