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CMS Releases 2019 Home Health Final Rule

On October 31, 2018, the Centers for Medicare and Medicaid Services (CMS) finalized calendar year 2019 and 2020 payment and policy changes for Home Health Agencies. Highlights of the final rule include 2019 payment changes to Home Health Agencies, a change in the home health episode from 60 day episodes of care to a 30 day periods of care in 2020, and a mandate that Medicare stop using the number of therapy visits provided to determine home health payment. CMS is also finalizing the implementation of the Patient-Driven Groupings Model (PDGM) for home health periods of care beginning on or after January 1, 2020.

To access a detailed fact sheet of the final rule as well as the final rule, log into your Gold Member account and click

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CMS to Host IRF Call

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CMS to Host IRF Call

The Centers for Medicare and Medicaid Services will host a call on November 15, 2018 beginning at 1:30pm ET to discuss changes finalized in the FY 2019 Inpatient Rehabilitation Facility (IRF) Prospective Payment System final rule. Topics include revisions to coverage criteria, removal of the Functional Independence Measure and associated function modifiers from the IRF – Patient Assessment Instrument, and refinements to the case mix classification.

For additional information and to register, click HERE.

Therapy Threshold, KX Modifier & The ABN FAQs

In this week’s article, I wanted to answer some of the most commonly asked questions I receive concerning the Medicare therapy threshold (formerly, the Medicare therapy cap), the KX modifier, claims exceeding $3,000 in a calendar year and when to and when not to use an advance beneficiary notice of noncoverage (ABN) for Medicare beneficiaries who exceed the annual therapy threshold and $3,000 in a calendar year. In this article, I will answer the following questions:

1. Why is it called the therapy threshold and not the therapy cap?

2. Why must I still use the KX modifier?

3. Will the annual therapy threshold dollar amount still increase each calendar year?

4. What is this $3,000.00 targeted medical review threshold?

5. Once a Medicare beneficiary exceeds the annual therapy threshold, do I use the KX modifier, issue an ABN or do both?

6. Once a Medicare beneficiary exceeds the annual targeted medical review threshold, do I use the KX modifier, issue an
ABN or do both?

7. Who is responsible for conducting the medical record reviews of claims that exceed the targeted medical review threshold?

8. What criteria is used to determine which claims that exceed $3,000 in a calendar year will be reviewed?

Lets begin!

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Therapy Threshold, KX Modifier & The ABN FAQs

This content is for Gold Members only. Please log in above or Register