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01/25/22

UHC Oxford Revises MPPR Policy

UnitedHealthcare (UHC) Oxford has revised their Multiple Therapy Procedure Reduction (MTPR) reimbursement policy with an effective date of December 1, 2021. In this policy, UHC Oxford lists the practice expense (PE) relative value unit (RVU) of each applicable CPT code so therapy providers will know which CPT code has the highest PE RVU and thereby will know the first unit of that code will not have their PE RVU decreased by 50%. Providers will then know which other CPT codes billed that day will have their PE RVU decreased by 50%. To access the revised policy, click

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01/24/22

Changes to amount in controversy (AIC) for appeals in 2022

The Centers for Medicare and Medicaid Services (CMS) has published the amount in controversy (AIC) for calendar year (CY) 2022 to appeal claims to the Administrative Law Judge (ALJ) level and/or Federal District Court level.

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01/17/22

SCOTUS Decides on CMS and OSHA Vaccine Mandates

On January 13, 2022, the Supreme Court of the United States (SCOTUS) decided the fate of the Centers for Medicare and Medicaid (CMS) vaccine mandate as well as the Occupational Safety and Health Administration (OSHA) vaccine mandate. In this article, I will provide answers to the following questions: Let’s Begin!

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01/14/22

Public Health Emergency: January 2022 Update

On January 14, 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 April 15, 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.

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01/03/22

Cohere to Manage Preauthorization for Humana in 2022

Beginning on January 1, 2022, Cohere will manage prior authorizations for outpatient therapy services for most Humana Commercial and Humana Medicare Advantage plans.

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01/03/22

Supervision Requirements of an Assistant in 2022

In this article, I will answer the following questions regarding the supervision requirements of a physical therapist assistant (PTA) by a physical therapist (PT) and an occupational therapy assistant (OTA) by an occupational therapist (OT) under Medicare Part B outpatient therapy services for calendar year 2022: Lets begin!

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01/03/22

Medicare Payment Amounts for 2022 – Examples

On November 2, 2021, the Centers for Medicare and Medicaid Services (CMS) released the calendar year (CY) 2022 Final Rule for services reimbursed under the Medicare Physician Fee Schedule (MPFS). This rule does apply to outpatient physical, occupational and speech therapy services provided in all outpatient therapy settings except a critical access hospital (CAH) since a CAH is not reimbursed under the MPFS. This proposed rule only applies to traditional Medicare and not Medicare Advantage plans. In the final rule, CMS stated the 2022 Conversion Factor (CF) would be 33.5983. This would be a 3.75% decrease compared to the 2021

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01/03/22

MIPS 2022 for PT, OT and SLP

For calendar year 2022, physical therapists, occupational therapists and speech-language pathologists will once again be considered Merit-Based Incentive Payment System (MIPS) eligible clinicians. In this article, I will answer some of the more frequent questions I receive about the MIPS program. In addition, I did a webinar on December 16, 2021 titled “2021 MIPS for Physical, Occupational and Speech Therapy Services“. For additional information on this webinar and to order the webinar playback link, click HERE. Question #1What practice setting(s) does MIPS apply to? Answer #1 Question #2Is there an easy way to know if I am a private practice

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