Effective July 1, 2014, physical therapists, occupational therapists, and speech-language pathologists in private practice will begin receiving updated Remittance Advice Remark Codes (RARCs) on their explanation of benefits (EOB’s) for PQRS claims-based reporting that went into effect on April 1, 2014. The new RARCs are as follows:

The Centers for Medicare and Medicaid Services released 3 proposed rules this week. The first, released July 1, 2014, is the calendar year 2015 proposed rule for services reimbursed under the Home Health Prospective Payment System. The second, released July 3, 2014, is the calendar year 2015 proposed rule for services reimbursed under the Medicare Physician Fee Schedule, that does include outpatient therapy services. The third, released July 3, 2014, is the calendar year 2015 proposed rule for the Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs. To access all the proposed rules, sign

A reopening is a remedial action taken to change a final determination or decision that resulted in either an overpayment or an underpayment, even though the determination was correct based on the evidence of the record. Reopenings are separate and distinct from the Medicare appeals process. Section 937 of the Medicare Modernization Act (MMA) required the Centers for Medicare and Medicaid Services (CMS) to establish a process whereby providers, physicians, and suppliers could correct minor error or omissions outside of the appeals process. CMS defines clerical errors (including minor errors or omissions) as human or mechanical errors on the part

I am often asked must physical therapists (PTs), occupational therapists (OTs), and speech-language pathologists (SLPs) in private practice enroll in the Medicare program if they want to treat Medicare beneficiaries? The answer is yes. PTs, OTs and SLPs in private practices do not have the option to opt out if they want to treat Medicare beneficiaries. They must become Medicare providers. This then leads to a second question I am often asked. If PTs, OT’s and SLPs must enroll in the Medicare program, what is this non-participating provider status? Doesn’t this mean I don’t participate with Medicare, hence, I can

UnitedHealthcare has announced they will implement the Medicare outpatient therapy functional limitation reporting effective with dates of service on and after

On May 22, 2014, the American Medical Association (AMA) and 3 hospitals filed a lawsuit to compel the Department of Health and Human Services (HHS) to meet statutory deadlines for timely review of Medicare claims denials. Currently, Medicare law requires an administrative law judge (ALJ) to hold a hearing and render a decision within 90 days. In December, the HHS’s Office of Medicare Hearings and Appeals imposed a moratorium on ALJ appeals. As of February 2014, there were 480,000 appeals awaiting assignment to an ALJ. To view a copy of the lawsuit, click HERE.

The Centers for Medicare and Medicaid Services has issued a special article to clarify the proper use of modifier 59. The article only clarifies existing policy. The article defines the definition of modifier 59 and provides several situations and examples when modifier 59 should be utilized. The article also defines which modifier should be used when a physician bills an E&M code on the same day as a non E&M code such as a physical therapy evaluation being billed incident-to a physician. To read the complete article, click

Do you want to know how many units of each CPT code you billed to the Medicare program and what Medicare paid you in 2012? Do you want to know the same of your competitors? This look-up tool is a searchable database that allows you to look up a provider by National Provider Identifier (NPI), or by name and location. The look-up tool will return information on services and procedures provided to Medicare beneficiaries, including utilization information, payment amounts (allowed amount and Medicare payment), and submitted charges organized by Healthcare Common Procedure Coding System (HCPCS) code. The data covers calendar