On June 20, 2013, the Centers for Medicare & Medicaid Services released the long awaited FAQs on the new Medicare G Codes and mandated reporting of patient functional limitation that becomes mandated to report on July 1, 2013. The document contains 22 FAQs on topics including how to report functional limitations, use of assessment tools, and claim requirements. To access this member only benefit, click

From APTA In response to concerns raised by APTA, providers, and other stakeholders, CMS has changed its functional limitation reporting instructions for claims submitted for each patient’s first visit on or after July 1, 2013. As a result of the change, therapy providers who have submitted functional limitation data (G-codes) on Medicare Part B patients prior to July 1

On each beneficiary’s first treatment date on or after July 1, physical therapists, occupational therapists, and speech-language pathologists must

Effective March 13, 2013 CMS Ruling 1455-R established an interim process allowing all hospitals to bill Medicare for Part B services after receiving a denial for a Part A inpatient admission claim as not reasonable and necessary. This process applies to Part A hospital inpatient claims that were denied by a Medicare review contractor because the inpatient admission was determined not reasonable and necessary, as long as the denial was made: (1) while this Ruling is in effect; (2) prior to the effective date of this Ruling, but for which the timeframe to file an appeal has not expired; or

Effective June 18, 2013, the Centers for Medicare & Medicaid Services (CMS) will allow providers with a physical disability to use a rubber stamp as signature when ordering or referring medical services for Medicare beneficiaries. To claim the signature exemption, providers with a physical disability must provide proof to a CMS contractor of their inability to sign their signature. With few exceptions, stamped signatures are not acceptable as described in Chapter/Section 3.3.2.4 of the Medicare Program Integrity Manual. To access the MLN Matters article, click HERE.

In the linked special edition article, the Centers for Medicare & Medicaid Services (CMS) clarifies policy for processing split claims for institutional providers that span the International Classification of Diseases, 10th Edition (ICD-10) implementation date of October 1, 2014. ICD-9 codes are effective for that portion of the services rendered on September 30, 2014, and earlier. ICD-10 codes are effective for that portion of the services rendered on October 1, 2014, and later. CMS will require providers to

Section 603(c) of the American Taxpayer Relief Act of 2012 (ATRA) changed the payment liability for denials resulting from the outpatient therapy caps from beneficiaries to providers effective January 1, 2013. Medicare systems were not updated in time to accurately represent this change on provider remittance advices (RAs). Medicare contractors may have already processed therapy cap denials for services provided in 2013. These denials incorrectly report on RAs beneficiary liability (Group Code “PR”) when liability legally rests with the provider (Group Code “CO”). Due to differing claims processing system constraints, this inaccurate RA reporting will be corrected beginning on different

During the week of May 6, 2013, the Centers for Medicare & Medicaid Services (CMS) issued 2 proposed rules. On May 6, 2103, CMS released the proposed rule for Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities for FY 2014. On May 8, 2013, CMS released the proposed rule for Inpatient Rehabilitation Facility Prospective Payment System for Federal Fiscal Year 2014.