On July 2, 2018, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule [CMS-1689-P] outlining proposed Calendar Year (CY) 2019 Medicare payment updates and proposed quality reporting changes for home health agencies (HHAs), and proposed case-mix methodology refinements and a change in the home health unit of payment from 60 days to 30 days for CY 2020. To view a Fact Sheet on the proposed rule, click HERE. To access the proposed rule, click HERE.

I receive many questions regarding Medicare Part B certifications and recertifications as they pertain to outpatient physical, occupational and speech therapy services. In this article, I will answer the following questions: 1. How long is a certification and recertification valid for under Medicare Part B outpatient therapy services? 2. How soon must a plan of care be signed by a physician or NPP to be considered timely under Medicare Part B rules and regulations? 3. What is delayed certification and recertification?  4. What are some possible justifications to support delayed certification or recertification? 5. If I only do an evaluation

The Centers for Medicare and Medicaid National Correct Coding Initiative (NCCI) edits effective with dates of service July 1, 2018 – September 30, 2018 is now available for my Gold Members. The outpatient therapy specific NCCI edit “cheat sheet” is available HERE. Please make sure to log into your account to access the “cheat sheet”.