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01/16/23

UnitedHealthcare Community Plan March 2023 Update

UnitedHealthcare (UHC) Community Plan will have a new outpatient therapy policy for facilities with an effective date of March 1, 2023. This policy will impact the following states: Per UHC, the policy summary is as follows:

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01/11/23

HHS Renews Public Health Emergency

On January 11, 2023, Secretary of Health and Human Services, Xavier Becerra, renewed the public health emergency (PHE) due to COVID-19. This means that the PHE will end at the end of the day on April 11, 2023 unless extended further. It’s widely expected that this is the last renewal and we should know next month if the PHE will not be renewed again. Click HERE to read the PHE extension notice.

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01/02/23

2023 MIPS Quality Measures Update

On December 27, the Centers for Medicare and Medicaid Services (CMS) released the 2023 Quality Measure Specifications and Supporting Documents for Medicare Part B Claims reporting and Registry Reporting. There were some surprises to the Quality Measures physical therapists (PTs) and occupational therapists (OTs) thought they would be able to report on in 2023 and one big surprise for speech-language pathologists (SLPs). Per the 2023 Final Rule for Services Reimbursed Under the Medicare Physician Fee Schedule, CMS finalized their proposal to add Quality Measures

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01/02/23

CMS Releases 2023 Quality Measure Specifications and Supporting Documents

On December 27, 2022, the Centers for Medicare and Medicaid Services released the 2023 Quality Measure Specifications and Supporting Documents for Medicare Part B claims reporting and Registry reporting. To access the 2023 Quality Measure Specifications and Supporting Documents, follow the instructions below:

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01/02/23

Medicare Estimated Payments for Outpatient Therapy in 2023

On November 1, 2022, the Centers for Medicare and Medicaid Services (CMS) released the calendar year (CY) 2023 final rule for services reimbursed under the Medicare Physician Fee Schedule (MPFS). Click HERE to read my summary on the final rule that will impact outpatient physical, occupational and speech therapy services in 2023. On December 22, 2022 and December 23, 2022, the United States Senate and United States House of Representatives, respectively, passed the Consolidated Appropriations Act, 2023. Included in this legislation was Congress providing additional funding to the Medicare program to help offset some, but not all, of the 4.47%

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12/26/22

Congress Passes 2023 Consolidated Appropriations Act

On December 22, 2022 and December 23, 2022, the United States Senate and United States House of Representatives, respectively, passed the Consolidated Appropriations Act, 2023. In this article, I will provide you with information contained in this ACT that impacts outpatient physical, occupational and speech therapy services.

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12/26/22

2023 Update on Telehealth

Due to passage of the Consolidated Appropriations Act, 2023, the Centers for Medicare and Medicaid Services will reimburse for outpatient therapy services provided by physical therapists, occupational therapists and speech-language pathologists delivered via telehealth in all outpatient settings through

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12/12/22

NCCI Edits Version 29.0

The National Correct Coding Initiative (NCCI) Edits, Version 29.0, become effective with dates of service January 1, 2023 – March 31, 2023. NCCI edits are used by the Centers for Medicare and Medicaid Services (CMS) to combat abusive and fraudulent billing practices. In addition, many state Medicaid programs, workers compensation carriers and commercial insurance carriers also utilize NCCI edits when processing outpatient physical, occupational and speech therapy claims. Gawenda Seminars & Consulting provides a NCCI Edit Therapy Specific reference sheet for our members that enable the members to know when modifier 59 is and is not required to be appended

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