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01/03/22

MIPS Quality Measures For 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 as they relate to the Quality Performance Measures. In addition, I did a webinar on December 16, 2021 titled “2022 MIPS for Physical, Occupational and Speech Therapy Services“. For additional information on this webinar and to order the webinar playback link, click HERE. Question #1In Performance Period 2022, how many quality measures must physical therapists, occupational therapists and speech-language

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01/03/22

Understanding the New Remote Therapeutic Monitoring CPT Codes

Effective January 1, 2022, there were 5 new CPT codes to describe remote therapeutic monitoring (RTM). In this article, I will answer the following questions I have been receiving about these new CPT codes. What are the new CPT codes that describe RTM and what is the description of each of the new RTM CPT codes? What is the difference between the new Remote Therapeutic Monitoring (RTM) codes and the existing Remote Physiological Monitoring (RPM) codes? Can physical therapists (PTs), occupational therapists (OTs) and speech-language pathologists (SLPs) bill the RTM codes to Medicare and other insurance carriers and be reimbursed

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01/03/22

UnitedHealthcare Medicare Advantage to Reduce Payment When Services Provided by an Assistant

UnitedHealthcare (UHC) has announced they will reduce payment when services are provided in whole or in part by a physical therapist assistant or an occupational therapy assistant to UHC Medicare Advantage beneficiaries. In this article, I will answer the following questions: When is the effective date of the payment reduction? What is the payment reduction? Will this payment reduction apply to outpatient therapy claims submitted on a 1500-claim form? Does this policy apply to out-of-network (OON) providers? Will this payment reduction apply to outpatient therapy claims submitted on a UB-04 claim form? Does this policy apply to UnitedHealthcare Commercial plans?

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01/03/22

UnitedHealthcare Commercial Updates for January 2022

UnitedHealthcare (UHC) Commercial has updated 2 of their Coverage Determination Guidelines that impact outpatient physical, occupational and speech therapy services as well as habilitative physical, occupational and speech therapy services with an effective date of January 1, 2022. In addition, UHC has issued 1 Reimbursement Policy Update. To access the 3 updated policies, log into your account and then click on the applicable link below. I hope you enjoyed this article. Thank you for being a Gold Member! All material posted on our website is intellectual property of Gawenda Seminars & Consulting, Inc. and can’t be used, reproduced, or posted

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12/27/21

Don’t Be Surprised by The No Surprises Act

The Centers for Medicare and Medicaid Services (CMS) has released a new Frequently Asked Question (FAQ) document on providing good faith estimates to uninsured and self-pay patients. Disclaimer: The information below and the answers to each question are accurate as of the posting of this article (December 27, 2021). As of this posting, we have been told that Subpart G – Protection of Uninsured or Self-Pay Individuals, does apply to outpatient physical, occupational and speech therapy services provided in all settings, including private practices. The Private Practice Section (PPS) of the American Physical Therapy Association (APTA) is seeking further clarification

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12/10/21

9.75% Medicare Payment Cut Partially Averted

The United States House of Representatives and United States Senate have both passed S. 610 which has 3 positive implications for providers of outpatient physical, occupational and speech therapy services for calendar year 2022. QuestionDoes S. 610 stop the 3.75% decrease in the 2022 Medicare Physician Fee Schedule Conversion Factor (CF) thereby halting the 3.75% percent decrease in payments for outpatient physical, occupational and speech therapy services in 2022? Answer QuestionDoes S. 610 stop the 4% pay-as-you-go (PAYGO) deficit control budget rules that was to go into effect in CY 2022 thereby further decreasing outpatient outpatient physical, occupational and speech

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12/07/21

First Coast Service Options TPE Review Topics

First Coast Service Options (FCSO), Medicare Administrative Contractor for the state of Florida, currently has 2 different Targeted Probe & Educate (TPE) reviews in process. If you are an outpatient rehabilitation facility (ORF), FCSO currently has a TPE in process looking at CPT codes 97110, 97112, and 97140. If you are a private practice, FCSO currently has a TPE in process looking at CPT code 97112. Click HERE for further details.

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12/06/21

UnitedHealthcare Community Plan December 2021 Update

UnitedHealthcare (UHC) Community Plan has issued an Outpatient Physical and Occupational Therapy Coverage Determination Guideline with an effective date of December 1, 2021. This Coverage Determination Guideline only applies to the states of Arizona, California, Hawaii, Kansas, Maryland, Michigan, New York, Ohio, Rhode Island, Virginia, Washington, and Wisconsin; however, this Coverage Determination Guideline has links to Outpatient Physical, Occupational and Speech Therapy Coverage Determination Guidelines for the states of Florida, Indiana, Kentucky, Nebraska, New Jersey and North Carolina. If you practice in one of the above mentioned states, this is definitely an article you want to read and understand. To

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