The Centers for Medicare and Medicaid Services (CMS), in collaboration with the CERT Part A and Part B MAC Outreach and Education Task Force,  has published a fact sheet discussing compliance with medical record documentation requirements. The fact sheet discusses third party additional documentation requests, insufficient documentation errors including physical therapy and provides resources of medical record documentation requirement. To access the fact sheet, click

On December 30, 2014, The Centers for Medicare and Medicaid Services (CMS) awarded the Region 5 Recovery Audit contract to Connolly, LLC. The Region 5 contract will be the national contract for DMEPOS and Home Health & Hospice claim reviews. As the current Recovery Audit contracts come to a close and the new contracts are being prepared, CMS has evaluated a number of concerns raised about the program and is now pleased to announce a number of changes to the Recovery Audit Program in response to industry feedback. These changes will be effective with each new contract beginning with the

The Centers for Medicare and Medicaid Services (CMS) has announced that Medicare Administrative Contractors will hold claims containing 2015 services paid under the MPFS for the first 14 calendar days of January 2015 (i.e., Thursday January 1 through Wednesday January 14). The hold should have minimal impact on provider cash flow as, under current law, clean electronic claims are not paid sooner than 14 calendar days (29 days for paper claims) after the date of receipt. MPFS claims for services rendered on or before Wednesday Dec 31, 2014 are unaffected by the 2015 claims hold and will be processed and paid

The Centers for Medicare and Medicaid Services (CMS) has responded to an inquiry by the American Physical Therapy Association, American Occupational Therapy Association and the American Speech-Language-Hearing Association as to when and whether physical therapists, occupational therapists and speech-language pathologists should use a new subset of modifiers that CMS announced in August 2014. At this time, CMS states for providers of outpatient therapy services to

The Centers for Medicare and Medicaid Services (CMS) implemented the Multiple Procedure Payment Reduction (MPPR) policy in 2011 to outpatient therapy services provided to Medicare beneficiaries seen by one or more disciplines on the same day by the same private practice or non-private practice setting (i.e. same group NPI number or Tax ID number). I am often asked how the MPPR is applied and to what CPT codes does the MPPR apply to. I will answer those 2 questions below and provide you with a reference document from CMS detailing which CPT codes the MPPR does apply to when billed

I receive many questions on the use of modifier 59 for outpatient therapy services. A few common questions I receive are “What is the definition of modifier 59?, When can I use modifier 59?” and my favorite “I have been told by my billing people that I can only use modifier 59 if I see the patient for 2 visits on the same day, not during a single visit, is that true?” I am going to answer the above 3 questions plus provide you with a document from the Centers for Medicare and Medicaid Services (CMS) that will support my

The Centers for Medicare & Medicaid Services (CMS) issued 2 transmittals providing details regarding the 2015 therapy cap dollar threshold and updating the annual therapy code list of which CPT codes will be considered “always therapy codes” or “sometimes therapy codes” and apply to the 2015 therapy cap dollar threshold. To access the transmittals, click

The Centers for Medicare and Medicaid Services (CMS) has finalized their changes to the 2015 PQRS program for physical and occupational therapists in private practice. Besides changes in the number of measures that must be reported, CMS is also implementing the requirement that if a physical or occupational therapist in private practice sees at least one Medicare patient in a face-to-face encounter, that they must report on at least one cross-cutting PQRS measure. The changes to the 2015 PQRS program, in addition to a listing of the new cross-cutting PQRS measures, are summarized below: