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03/27/23

NCCI Edits for April through June 2023

The Centers for Medicare and Medicaid Services (CMS) will not be releasing a 2023 second quarter NCCI edits update. CMS has instructed Medicare Administrative Contractors as well as suppliers and providers of outpatient therapy services to continue to use the 2023 1st quarter NCCI edits until they release the 2023 3rd quarter NCCI edits. To access the 2023 1st quarter NCCI edits specific to outpatient therapy, click HERE.

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03/27/23

UnitedHealthcare Appeals Must be Submitted Electronically

On January 16, 2023, I published an article titled “UnitedHealthcare Transitioning to Electronic Claim Reconsiderations and Post-Service Appeals“. As a reminder, you have 2 options how to submit claim reconsiderations and post-service appeals electronically. The first is through the UnitedHealthcare Provider Portal and the second is through the Application Programming Interface. For detailed instructions on the 2 options, click

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03/20/23

Billing for Speech-Language Pathology Clinical Fellows

In this article, I will provide answers to the following questions regarding the billing of outpatient therapy services provided by a Speech-Language Pathology Clinical Fellow:

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03/13/23

Does Aetna Medicare Advantage Follow Medicare’s “8-Minute Rule”?

In this article, I will answer the following questions:

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03/13/23

Do Medicare Advantage Plans Follow Medicare’s “8-Minute Rule”

In 2000, the Centers for Medicare and Medicaid Services (CMS) implemented what has been called “Medicare’s 8-minute rule” for the billing of 15-minute time-based CPT codes for outpatient therapy services. What providers of outpatient therapy services want to know is does Medicare’s “8-minute rule” automatically apply to all Medicare Advantage plans. In this article, I will answer the following questions:

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03/06/23

What is the Entitlement Date of a Newly Enrolled Medicare Beneficiary?

On October 28, 2022, the Centers for Medicare and Medicaid Services (CMS) issued a final rule that implements certain provisions of the Consolidated Appropriations ACT, 2021 such as revising the effective dates of coverage for a newly eligible and enrolled Medicare beneficiary. In this article, I will answer the following questions:

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02/27/23

Acute Care Documentation and Billing

I am often asked to provide webinars, seminars and consultative services on acute care/inpatient documentation and billing as they pertain to physical, occupational and speech therapy services. In this article, I will answer the following questions:

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02/20/23

Supervision Requirements of an Assistant in 2023

In this article, I will answer the following questions regarding the supervision requirements of a physical therapist assistant (PTA) by a physical therapist (PT) and an occupational therapy assistant (OTA) by an occupational therapist (OT) under Medicare Part B outpatient therapy services for calendar year 2023:

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