The Centers for Medicare and Medicaid Services has released revised instructions regarding the 1500 claim form to reflect the revised 1500 claim form, version 02/12. The revised form, 02/12, will replace the current Form CMS-1500, 08/05, effective with claims received on and after

The CMS-1500 Claim Form has been revised to support the ICD-10 diagnosis codes. Medicare will begin accepting the revised forms on January 6, 2014. Starting April 1, 2014, Medicare will accept only the revised version of the form. Only providers who qualify for exemptions from electronic submission may submit the CMS-1500 claim form. Additional information is posted to the September 12, 2013 MLN Connects Provider e-news.

It is the beginning of 2014 and you’ll be verifying your patient’s insurance status when they show up in your office for their first therapy visit of the New Year. With the beginning of the Health Insurance Marketplace, also known as Health Insurance Exchange, over a million people will have a new insurance plan in 2014. In many cases, this will be the first time they have had insurance in years. Many of these people will have signed up for their plan within the past few days. They may not have received their card yet or they may be unaware

On December 26, 2013, President Obama signed into law the Pathway for SGR Reform Act of 2013. This new law has several “fixes” important to providers of outpatient therapy services related to the 20.1% scheduled reduction in Medicare payment in 2014, the therapy cap application to hospital outpatient departments in 2014, the therapy cap exception process (i.e. use of KX modifier) in 2014, and the manual medical review process for when the beneficiary has reached a dollar aggregate threshold amount of $3,700. This new law takes effect on January 1, 2014. Here is how the new law impacts providers of

From the Centers for Medicare and Medicaid Services (CMS): On January 24, 2013, the U. S. District Court for the District of Vermont approved a settlement agreement in the case of Jimmo v. Sebelius,  involving skilled care for the inpatient rehabilitation facility (IRF), skilled nursing facility (SNF), home health (HH), and outpatient therapy (OPT) benefits. “Nothing in this Settlement Agreement modifies, contracts, or expands the existing eligibility requirements for receiving Medicare coverage.” The goal of this settlement agreement is to ensure that claims are correctly adjudicated in accordance with existing Medicare policy, so that Medicare beneficiaries receive the full coverage

On the CERT Contractor Call, providers were notified of CMS’ intent to change the response time for CERT requests for Initial Documentation to 60 days, down from 75 days. It is important that providers respond to any CERT Initial Documentation requests on or after January 1, 2014, within 60 days. Make a note that the follow-up call and letter time frame from CERT will change as well: Day 0: Contact and/or send letter 1 via fax or mail Day 30: Contact and/or send letter 2 via fax or mail Day 45: Contact and/or send letter 3 via fax or mail

On December 18, 2013, the Senate passed the House bi-partisan budget bill which contains important provisions for providers of outpatient therapy services. The bill addresses the 20.1% reduction scheduled to begin on January 1, 2014, the therapy cap exception process (i.e. use of KX-modifier), the status of hospital outpatient departments and the therapy cap in 2014, and the $3700 threshold manual medical review process. Here is the detailed summary. The bill provides

The Centers for Medicare and Medicaid Services (CMS) have announced that the Medicare Policy Manuals have been revised pursuant to the Jimmo vs. Sebelius Settlement. The Jimmo case ended a longstanding practice denying Medicare coverage to people who  had “plateaued,” or were “chronic,” or “stable,” or “not likely to improve.” The Manual revisions clarify that improvement is not required to obtain Medicare coverage and the revisions pertain to care in Skilled Nursing Facilities (SNF), Home Health care (HH), and Outpatient Therapies (OPT) as well as a Medicare beneficiary does not need to return to their prior level of function for