In November 2014, the Centers for Medicare and Medicaid Services (CMS) released the final rules for the outpatient prospective payment system (OPPS) and the Medicare Physician Fee Schedule (MPFS) for calendar year (CY) 2015. In the OPPS final rule, CMS finalized they will begin to collect data on services furnished in off-campus provider-based departments in CY 2015. Hospitals will be required to report the HCPCS “PO” modifier with every code on facility claims for outpatient hospital services furnished in off-campus provider-based departments. Reporting will be voluntary for CY 2015, mandatory reporting will start January 1, 2016. The question I am

Currently, providers can use the -59 modifier to indicate that a code represents a service that is separate and distinct from another service with which it would usually be considered to be bundled. The primary issue associated with the -59 modifier is that it is defined for use in a wide variety of circumstances, such as a use to identify different encounters, different anatomic sites, and distinct services. Usage to identify a separate encounter is infrequent and usually correct; usage to define a separate anatomic site is less common and problematic; usage to define a distinct service is common and

The Centers for Medicare and Medicaid Services (CMS) has extended the deadline for requesting an informal review for eligible professionals, CPC practice sites, PQRS group practices, and ACOs that believe they have been incorrectly assessed the 2016 PQRS negative payment adjustment based on their 2014 PQRS submissions. The new deadline for submission of the review request is

On November 6, 2015, the Centers for Medicare and Medicaid Services (CMS) released revised additional documentation request (ADR) limits for non-private practice settings. This would include skilled nursing facilities, home health agencies, rehabilitation agencies, comprehensive outpatient rehabilitation facilities and hospitals. This would apply to both Part A and Part B services and Part B services would include outpatient therapy. The annual ADR Limit will be one-half of one percent (0.5%) of the provider’s total number of paid Medicare claims from the previous year. ADR letters are sent on a 45-day cycle. The annual ADR Limit will be divided by eight

Currently, providers can use the -59 modifier to indicate that a code represents a service that is separate and distinct from another service with which it would usually be considered to be bundled. The primary issue associated with the -59 modifier is that it is defined for use in a wide variety of circumstances, such as a use to identify different encounters, different anatomic sites, and distinct services. Usage to identify a separate encounter is infrequent and usually correct; usage to define a separate anatomic site is less common and problematic; usage to define a distinct service is common and

Novitas Solutions, Medicare Administrative Contractor for the states of Arkansas, Colorado, Louisiana, Mississippi, New Mexico, Oklahoma, and Texas, has announced their upcoming focus of provider specific reviews and to no ones surprise, some of the CPT codes to be reviewed impact outpatient physical and occupational therapy services. CPT codes 97112 (neuromuscular reeducation), 97140 (manual therapy) and 97530 (therapeutic activities) have been listed as part of Novitas Solutions upcoming provider specific reviews. Click HERE for a full listing of the CPT codes.

Currently, providers can use the -59 modifier to indicate that a code represents a service that is separate and distinct from another service with which it would usually be considered to be bundled. The primary issue associated with the -59 modifier is that it is defined for use in a wide variety of circumstances, such as a use to identify different encounters, different anatomic sites, and distinct services. Usage to identify a separate encounter is infrequent and usually correct; usage to define a separate anatomic site is less common and problematic; usage to define a distinct service is common and

On October 30, 2015, the Centers for Medicare and Medicaid Services (CMS) issued “Proposed policy, payment, and quality provisions changes to the Medicare Physician Fee Schedule for Calendar Year 2016” final rule updating payment policies, payment rates, and quality provisions for services furnished under the Medicare Physician Fee Schedule (PFS) on or after January 1, 2016. CMS finalized a number of new policies, including several that are a result of recently enacted legislation. The rule also finalizes changes to several of the quality reporting initiatives that are associated with PFS payments, including the Physician Quality Reporting System (PQRS), the Physician