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05/09/22

Does CMS Limit Outpatient Therapy Units

Question A question I often receive is does the Centers for Medicare and Medicaid Services (CMS) limit the number of total units that can be billed per day by type of discipline (e.g., PT, OT, SLP)? Answer

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05/02/22

Electrical Stimulation and One-on-One Interventions at the Same Time: How to Bill

I am often asked what is the correct billing when I set a patient up on unattended electrical stimulation and then while the patient is on the unattended electrical stimulation, I am also providing them with skilled one-on-one interventions that would be included within therapeutic exercise, neuromuscular reeducation and/or therapeutic activities. In this article, I will provide the answer to this billing question with the rationale for the answer. QuestionWhat is the correct billing when I set a patient up on unattended electrical stimulation and then while the patient is on the unattended electrical stimulation, I am also providing them

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04/25/22

Outpatient Therapy at Multiple Clinics During Same Time Period

A question I receive often is can a patient receive the same discipline of therapy at 2 different facilities during the same time period and have both services reimbursed by the insurance carrier. In this article, I will answer the following questions:

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04/13/22

Public Health Emergency: April 2022 Update

On April 12, 2022, Secretary of Health and Human Services Xavier Becerra renewed the Public Health Emergency (PHE) due to COVID-19. The new expiration date of the PHE is the end of the day on July 14, 2022. Regarding what does this mean for the Medicare program continuing to pay for telehealth if provided by a physical therapist, physical therapist assistant, occupational therapist, occupational therapy assistant and speech-language pathologist, click HERE and read the first question and answer. In addition, to learn how long the Medicare program will reimburse for outpatient physical, occupational and speech therapy services provided via telehealth once the

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04/11/22

CMS Releases SNF FY 23 Proposed Rule

On April 11, 2022, the Centers for Medicare and Medicaid Services (CMS) released the fiscal year (FY) 2023 proposed rule for skilled nursing facilities for Part A services reimbursed under Patient Driven Payment Model. Comments on the proposed rule must be received by June 10, 2022. To access the proposed rule, click

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04/11/22

CMS Releases IRF FY 2023 Proposed Rule

On March 31, 2022, the Centers for Medicare and Medicaid Services (CMS) released the fiscal year (FY) 2023 proposed rule for Inpatient Rehabilitation Facilities. The proposed rule was published on April 6, 2022 and CMS is accepting comments on the proposed rule until 5:00pm on May 31, 2022. To access the proposed rule, click

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03/28/22

NCCI Edits Version 28.1 Effective April 1, 2022

National Correct Coding Initiative (NCCI) Edits Version 28.1 are effective with dates of service April 1, 2022 – June 30, 2022. To access Gawenda Seminars & Consulting, Inc. therapy specific NCCI edit reference sheet that will assist you in determining whether modifier 59 is required or not, click HERE.

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03/21/22

Does One-on-One Only Apply to Traditional Medicare?

I receive many questions at my in-person seminars and via email that begin something like “I know we can’t have 2 Medicare patients being treated at the same time, but how about 2 patient’s with private insurance”? Or, “I know I need to be one-on-one with Medicare patient’s, but that does not apply to patients with private insurance, right”? Lastly, “I know if I have 2 Medicare patient’s in my facility for one hour during the same time period, I have to split the time between them, but if the 2 patient’s had private insurance, I could bill each for

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