Skilled nursing facilities initiating compliance programs are encouraged to review Program for Evaluating Payment Patterns Electronic Report (PEPPER) reports recently sent to each facility by the Centers for Medicare & Medicaid Services (CMS). These free provider-specific comparative data reports help identify billing practices which may be at risk for administrative review. CMS began mailing PEPPER to skilled nursing facilities in August 2013. PEPPER, or program for evaluating payment patterns electronic report, provides facility-specific data statistics for services provided to Medicare beneficiaries. PEPPERs compare a SNF’s claims data statistics with aggregate statistics from similar facilities in the state, Medicare administrative jurisdiction,

On August 23, 2013, the Centers for Medicare and Medicaid Services (CMS) issued a memorandum to state survey agency directors about MDS 3.0 discharge assessments that have not been completed and/or submitted. The memo is intended to help surveyors understand both (a) what nursing homes should do to address inactive residents remaining on their resident roster due to incomplete and/or unsubmitted discharge assessments and (b) how nursing homes can ensure compliance with discharge assessment requirements. CMS is providing this information in order to promote nursing home completion of discharge assessments for inactive residents by September 30, 2013. Beginning October 1,

On September 5, 2013, the Centers for Medicare and Medicaid Services (CMS) issued a five-page document clarifying the types of practitioners who may furnish orders for inpatient services and the types of information that must be included in those orders. In the document, the CMS discusses the physician certification and practitioner orders.

Wisconsin Physician Services (WPS), Medicare Administrative Contractor for the states of Indiana, Iowa, Kansas, Michigan, Missouri, and Indiana, has add 12 new outpatient therapy FAQs to their website for practices in the above mentioned states. Topics include billing and coding, documentation, functional reporting, modifiers, and general FAQs. To access the FAQs, click

Lawmakers in Washington DC are working hard this year to repeal the sustainable growth rate (SGR) formula used to determine payment under the Medicare Physician Fee Schedule (MPFS), that does include outpatient therapy services. A major stumbling block in the repeal is the additional cost to the Medicare program that would occur due to the repeal. Due to the Statutory Pay-As-You-Go Act, Congress must ensure that most new spending is offset by spending cuts or added revenue elsewhere. H.R. 2810, the Medicare Patient Access and Quality Improvement Act, adds several new items of spending without offering ways to pay for

In their September 2013 issue of OfficeLink Updates Newsletter, Aetna provides clarification on how often re-evaluations are eligible for payment for outpatient physical therapy, occupational therapy, and speech-language pathology services. Physical and occupational therapy re-evaluations (97002 and 97004) are eligible for payment

At its August 1, 2013 meeting in Chicago, The National Uniform Claim Committee (NUCC) approved a transition timeline for the version 02/12 1500 Health Insurance Claim Form (1500 Claim Form).  In June, the NUCC announced the approval of the updated 1500 Claim Form that accommodates reporting needs for ICD-10 and aligns with requirements in the Accredited Standards Committee X12 (ASC X12) Health Care Claim: Professional (837P) Version 5010 Technical Report Type 3. The transition timeline for the revised 1500-claim form is as follows:

On July 1, 2013, the Centers for Medicare and Medicaid Services (CMS) issued a revised MLN Matters publication on expedited determinations for provider service terminations. This MLN Matters® Article is intended for Home Health Agencies (HHAs), Comprehensive Outpatient Rehabilitation Facilities (CORFs), Hospices, and Skilled Nursing Facilities (SNFs) providing services to Medicare beneficiaries. This has implications for therapy services reimbursed under both Part A and Part B benefits. Topics discussed include: Health Care Settings in Which the Expedited Determination Process is Available to Beneficiaries, Care Settings in which Notice of Medicare Non-Coverage (NOMNC) Delivery Does Not Apply, NOMNC Preparation and Delivery, Amending