On April 9, 2014, The Centers for Medicare and Medicaid Services (CMS) announced the release of new, privacy-protected data on services and procedures provided to Medicare beneficiaries by physicians and other health care professionals. The new data also show payment and submitted charges, or bills, for those services and procedures by provider. The new data set has information for over 880,000 distinct health care providers, including physical, occupational and speech therapists in private practice, who collectively received $77 billion in Medicare payments in 2012, under the Medicare Part B Fee-For-Service program. With this data, it will be possible to conduct

Providers who currently submit paper claims to Medicare must begin using CMS-1500 form 02/12 for paper claim submissions received on or after April 1, 2014. On June 10, 2013, the White House OMB approved the revised CMS-1500 claim form, version 02/12, OMB control number, 0938-1197. The CMS-1500 claim form is the required format for submitting claims to Medicare on paper. If providers submit paper claims via the CMS-1500 08/05 version on or after April 1, 2014 to their Medicare Administrative Contractor, the claim(s) will be rejected and returned as unprocessable. Providers will be instructed to resubmit a claim(s) using the

Gold Members, please log in to read about breaking new information concerning the 2014 therapy cap exception process, payment update for services reimbursed under the Medicare Physician Fee Schedule and breaking news about ICD-10 implementation. Not yet a Gold Member? Join HERE and get access to all the information on the website, monthly electronic member only newsletters, and member only breaking news email updates. On March 31, the United States Senate passed

The Centers for Medicare and Medicaid Services have issued clarification instructions on the use of the skilled nursing facility (SNF) Advance Beneficiary Notice (ABN) of Non-Coverage form pursuant to the Jimmo vs Sebelius settlement. The instructions cover common denial reasons why the extended care items or services are noncovered under Medicare. The SNF may use these denial paragraphs as inserts in the “Because” and “Items or Services” sections of the SNF ABN. Denial paragraphs provided by CMS include, but are not limited to, teaching and training activities – partial denial, teaching and training activities – no skilled services, teaching or

If Congress does not pass additional legislation either eliminating the therapy cap or extending the exception process prior to April 1, 2014, Medicare beneficiaries will not have coverage for outpatient therapy services once they exceed $1920 PT and SLP combined or a separate $1920 for occupational therapy. If no legislation is passed and no exception process is in place, therapy provided above the $1920 would be considered

First Coast Service Options, National Government Services (NGS) and Novitas Solutions have announced that claims reporting Outpatient Therapy Functional G-codes and modifier information may be incorrectly receiving errors from the Common Working File (CWF) causing incorrect denials. The issues have been referred to CWF system maintainer for research and resolution. CWF has acknowledged an issue that is causing some of the incorrect denials and they are working on a resolution.  However, CWF is also researching other potential issues related to the G-code processing. Further instructions will be provided once CWF has completed their research and any required system corrections. Even

The Humana health insurance corporation has nearly completed processing refunds owed to practitioners who were incorrectly billed during an “overpayment recovery” process last year. The overpayments were part of Humana’s attempt to implement the multiple procedure payment reduction (MPPR) policy retroactively, and the problems have contributed to a Humana decision to hold off on full MPPR implementation until the system can run more smoothly. Humana will delay MPPR implementation until

On February 18, 2014, the Centers for Medicare and Medicaid Services (CMS) announced they will pause recovery audits since they are in the procurement process for the next round of Recovery Audit Program contracts. This will allow the Recovery Auditors time to complete all outstanding claim reviews and other processes by the end date of the current contracts.  In addition, a pause in operations will allow CMS to continue to refine and improve the Medicare Recovery Audit Program. February 21, 2014 is the last day a Recovery Auditor may send a postpayment Additional Documentation Request (ADR). February 28, 2014 is