On April 21, 2016, the Centers for Medicare and Medicaid Services (CMS) released the skilled nursing facility (SNF) proposed rule for FY 2017 for services reimbursed under Medicare Part A benefits. Based on the proposed rule, CMS projects payments for SNF’s will increase by 2.1% in FY 2017 compared to FY 2016. The 2017 proposed rule adds to the list of quality measures that will be required of SNFs beginning in 2018 to include data on discharge to community, Medicare spending per beneficiary, and potentially preventable 30-day readmissions. The proposal also stipulates that by 2020, SNFs will be required to

On April 21, 2016, the Centers for Medicare and Medicaid Services (CMS) released FY 2017 Inpatient Rehabilitation Facility (IRF) proposed rule. In the proposed rule, CMS is proposing to increase IRF payment by 1.45% in FY 2017 compared to FY 2016. Beginning in FY 2014, any IRF that does not submit the required data to CMS receives a 2.0 percentage point decrease in its annual increase factor for payments under the IRF PPS. The Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act) requires the continued specification of quality measures, as well as resource use and other measures, for

I often have therapists tell me that they have to do a reevaluation on all of their patient’s every 30 days from the date of the patient’s initial evaluation. I then ask them why they think that is a requirement. Their response is usually along the lines of “Medicare requires we do a reevaluation every 30 days” or “my state practice act requires we do a reevaluation every 30 days” or “my employer or my organization requires we do a reevaluation every 30 days.” In this article, I will address the above 3 responses and explain why it probably is

The Centers for Medicare and Medicaid Services (CMS) has released Skilled Nursing Facility (SNF) utilization and payment data for 2013. In addition to information on payments and charges, the SNF Payment Public Use File (PUF) contains information on two categories of RUGs for patients who receive a significant amount of therapy: Ultra-High (RU) and Very High (RV) Rehabilitation RUGs. Consistent with prior CMS findings, the SNF PUF shows that for these two RUGs, the amount of therapy provided is often very close to the minimum amount of minutes needed to qualify a patient for these categories.  Medicare SNF per diem

Physical therapists bill CPT code 97002 for a reevaluation. Occupational therapists bill CPT code 97004 for a reevaluation. But what CPT code do speech-language pathologists (SLPs) use to bill for a reevaluation? The answer depends on who is the insurance carrier and what is their policy. And did you also know that SLPs do have a reevaluation code that some private insurance carriers list as payable in their speech-language pathology policies? In this article, I will explain how to bill for a reevaluation to Medicare and private insurance carriers, reveal the reevaluation code that SLPs have and list several insurance

As I speak around the country, I am often surprised how many providers are not aware of CPT codes that speech-language pathologists (SLPs) could and should be using to bill to an insurance carrier for the evaluation of a speech-generating augmentative and alternative communication device (SGD). A SGD is a device that produces digital or synthesized speech. In this week’s article, I will explain how to use the evaluation CPT codes for an evaluation for a SGD as well as how to bill for the programming, modification and patient education and training associated with a SGD. Lets begin with the

In last weeks article, “When to Bill For a Reevaluation”, I discussed when it would be appropriate to perform and bill for a reevaluation. In this weeks article, I want to teach you how to account for your time when you are gathering subjective comments from a patient or their caregiver as well as the time you spend gathering objective data to write a Progress Report that may be required by the insurance carrier (i.e. Medicare, Workers Compensation) or due to the patient having a return visit to their physician. To begin, there is no CPT code that exists to

I am frequently asked when is it appropriate to bill a reevaluation to an insurance carrier? Is it appropriate to bill when I am doing a Progress Report on a patient? Is it appropriate to bill for the purpose of completing a recertification on a Medicare patient? Is it appropriate to bill on the day I am also reporting the functional limitation reporting G-codes on a Medicare patient? In this article, I will answer the above 4 questions and provide you with the main criteria when a reevaluation would be appropriate to perform on a patient and bill to the