The Office of the Inspector General (OIG) released a report on November 9, 2012 that reveals SNFs billed one-quarter of all claims in error in 2009, resulting in $1.5 billion in inappropriate Medicare payments. The majority of the claims in error were upcoded; many of these claims were for ultrahigh therapy. The remaining claims in error were downcoded or did not meet Medicare coverage requirements. To read the full report from the OIG, click…

The Centers for Medicare and Medicaid Services (CMS) has established a new place of service (POS) code for patients receiving therapy services at their worksite. The new POS code is…

The following Question and Answer (Q&A) summary is from the Medicare web-based training workshop titled “Manual Medical Review Threshold ($3700) Process” and ENCORE held September 27 and October 3, 2012. In some cases, the original questions have been edited for clarity, and answers given during the call may have been expanded to provide further detail and multiple questions have been combined. To access the Q&A document, click…

Today, the Centers for Medicare and Medicaid Services (CMS) issued the final rule for services reimbursed under the Medicare Physician Fee Schedule that includes outpatient therapy services. For therapy services, begin reading on page 68958 and continue through page 68978 of the pdf document. The therapy cap dollar amount will be…

Protests have been filed against the Jurisdiction E A/B MAC contract, Jurisdiction 6 A/B MAC contract, and Jurisdiction L A/B MAC contract. The protests impact the states of California, Delaware, Hawaii, Illinois, Maryland, Minnesota, Nevada, New Jersey, Pennsylvania, Wisconsin, as well as the District of Columbia.

The Centers for Medicare & Medicaid Services has published a MedLearn Matters article as an educational guide to improve compliance with documentation requirements for major joint replacement surgery (i.e. knee and hip). To read the article and how physical therapy plays a role in the decision the Medicare contractor will make when deciding to pay or not pay for the procedure, click…

Novitas Solutions transitioned as the Part A MAC for non-private practice settings in the states of Colorado, New Mexico, Oklahoma, and Texas on October 29, 2012. Transition news can be found

The Office of the Inspector General (OIG) has released their 2013 work plan. To no ones surprise, rehab is on their radar. For IRF, the OIG will look at appropriateness of admission and level of therapy. The OIG work plan will also focus on independent physical therapists in private practice and high utilization of outpatient PT services. To read the work plan, click…