The Centers for Medicare and Medicaid Services (CMS) has released the results of the ICD-10 end-to-end testing week that was conducted from January 26, 2015 through February 3, 2015. CMS received 14,929 test claims and 12,149 were accepted for an 81% acceptance rate. Reasons for rejected claims * 3% – Invalid submission of ICD-9 diagnosis or procedure code * 3% – Invalid submission of ICD-10 diagnosis or procedure code * 13% – Non-ICD-10 related errors, including issues setting up the test claims (e.g., incorrect NPI, Health Insurance Claim Number, Submitter ID, dates of service outside the range valid for testing,

On February 11, 2015, the American Hospital Association (AHA) urged the Health Subcommittee of the Committee on Energy and Commerce of the U.S. House of Representatives to oppose any further delays to the implementation of ICD-10 scheduled for October 1, 2015. The AHA noted that 93% of hospitals surveyed this year were moderately to very confident they could meet the October 1, 2015 implementation deadline. Previous delays in the implementation of ICD-10 has cost health plans Medicare, Medicaid, hospitals and large providers anywhere from $1.2 billion and $6.9 billion. To read the AHA statement, click HERE.

Priority Health in the state of Michigan has announced they will provide coverage for patients to access physical therapy services without requiring a referral as allowed by the law for commercial products. This is due to a state law that took effect January 1, 2015 allowing anyone to seek physical therapy services without a physician referral for up to 21 days or 10 visits, whichever comes first. Medicaid patients still require a referral for physical therapy services as mandated by the state. To access this decision, click will provide coverage for patients to access physical therapy services as allowed by

The Centers for Medicare and Medicaid Services has issued a change request to address the new prepayment review timeframe for Additional Documentation Requests (ADRs) submission. The change request instructs Medicare Administrative Contractors, Recovery Auditors, and Comprehensive Error Rate Testing contractors to allow

The Medicare Learning Network hosted a National Provider Call on January 15, 2015 from 1:30pm – 3:00pm ET on the new IRF-PAI items that become effective on October 1, 2015. The agenda included the following items: Arthritis attestation: Item 24A Therapy information section: Items O0401 and O0402 Signature page clarification: Item Z0400A To access the IRF-PAI training manual, a pdf version of the presentation and an audio recording and written transcript of the educational session, click

The Centers for Medicare and Medicaid Services (CMS) has issued additional guidance regarding the new subsets of modifier 59 (i.e. XE, XP, XS, and XU) that became effective January 1, 2015 and the continued use of modifier 59 after January 1, 2015. In the updated guidance, CMS states providers may continue to use modifier 59 after January 1, 2015 in any instance in which it was correctly used prior to January 1, 2015. Additional guidance and education as to the appropriate use of the new modifiers will be forthcoming as CMS continues to introduce the modifiers in a gradual and

Highmark Blue Shield will require therapy providers to append a new modifier to CPT codes for outpatient therapy services when those outpatient therapy services are for

For services reimbursed under the Medicare Physician Fee Schedule (MPFS), claims with dates of service on or after April 1, 2013 will continue to incur a 2% reduction in Medicare payment through March 31, 2015. I am often asked how the sequestration reduction impacts payment from the Medicare Administrative Contractor, how it impacts the calculation of the Medicare allowed amount that is applied to the annual therapy cap dollar threshold and how it impacts the Medicare patient’s financial responsibility in terms of co-insurance and/or deductible. To obtain the answers to above the questions, please log into your Gold Member account