If Congress does not pass additional legislation either eliminating the therapy cap or extending the exception process prior to April 1, 2014, Medicare beneficiaries will not have coverage for outpatient therapy services once they exceed $1920 PT and SLP combined or a separate $1920 for occupational therapy. If no legislation is passed and no exception process is in place, therapy provided above the $1920 would be considered

Wisconsin Physician Services (WPS) will be hosting several teleconferences in the month of April. The first will occur on April 9, 2014 and will focus on the Advance Beneficiary Notice of Noncoverage. WPS will also be doing a 2-part teleconference titled “Outpatient Therapy Guidelines” with Part 1 occurring on April 22, 2014 and Part 2 on April 24, 2014.

First Coast Service Options, National Government Services (NGS) and Novitas Solutions have announced that claims reporting Outpatient Therapy Functional G-codes and modifier information may be incorrectly receiving errors from the Common Working File (CWF) causing incorrect denials. The issues have been referred to CWF system maintainer for research and resolution. CWF has acknowledged an issue that is causing some of the incorrect denials and they are working on a resolution.  However, CWF is also researching other potential issues related to the G-code processing. Further instructions will be provided once CWF has completed their research and any required system corrections. Even

The Humana health insurance corporation has nearly completed processing refunds owed to practitioners who were incorrectly billed during an “overpayment recovery” process last year. The overpayments were part of Humana’s attempt to implement the multiple procedure payment reduction (MPPR) policy retroactively, and the problems have contributed to a Humana decision to hold off on full MPPR implementation until the system can run more smoothly. Humana will delay MPPR implementation until