Wisconsin Physician Services, Medicare Administrative Contractor for the states of Iowa, Kansas, Missouri and Nebraska, has announced they will begin a new Targeted Probe & Educate topic for private practices in the before mentioned states. The topic will focus on CPT code 97110, therapeutic exercise to improve strength and endurance, range of motion and flexibility. For additional information, click HERE.
The Centers for Medicare and Medicaid Services (CMS) has announced the 2019 Medicare Part A and Part B premiums and deductibles. In this article, I will provide you with what the premiums and deductibles are for 2019 and how the Medicare beneficiaries Part B deductible can impact the annual therapy threshold dollar amount dependent upon was the deductible met before or after they received outpatient physical, occupational and/or speech therapy services.
Lets begin with the 2019 Part B deductible and monthly premiums. In 2019, the Part B deductible will be
The Centers for Medicare and Medicaid Services (CMS) has released data that provides important premium and cost sharing information for Medicare health and drug plans offered in 2019. According to the CMS Fact Sheet:
- Enrollment in Medicare Advantage is projected to be at an all-time high in 2019 with 22.6 million Medicare beneficiaries. This represents a projected 2.4 million (11.5 percent) increase from 20.2 million in 2018. Based on projected enrollment, 36.7% of Medicare beneficiaries will be enrolled in Medicare Advantage in 2019.
- Medicare Advantage premiums, on average, have steadily declined since 2015 from the actual average premium of $32.91. For 2019, CMS estimates the Medicare Advantage average monthly premium will decline by $1.81 to $28.00 from 2018.
- Approximately 83 percent of Medicare Advantage enrollees will have the same or lower premium in 2019 if they continue in the same plan. About 26 percent of enrollees staying in current plans will see their premiums decline in 2019. Approximately 46 percent of enrollees in their current plan will have a zero premium in 2019.
- Access to Medicare Advantage and prescription drug plans will remain nearly universal, with about 99 percent of Medicare beneficiaries having access to at least one health plan in their area. All Medicare beneficiaries will have access to at least one stand-alone prescription drug plan.
- Nationally, the number of Medicare Advantage plan choices will increase from about 3,100 in 2018 to about 3,700 in 2019 – and more than 91 percent of people with Medicare with have access to 10 or more Medicare Advantage plans in 2019, compared to nearly 86 percent in 2018.
- The average number of Medicare plan choices per county will increase by 5 plans – up to approximately 34 plan choices per county.
- Due to new flexibilities available for the first time in 2019, nearly 270 Medicare Advantage plans will be providing an estimated 1.5 million enrollees new types of supplemental benefits:
- Expanded health-related supplemental benefits, such as adult day care services, and in-home and caregiver support services; and
- Reduced cost sharing and additional benefits for enrollees with certain conditions, such diabetes and congestive heart failure due to the agency’s reinterpretation of uniformity requirements.
- Access to important supplemental benefits, such as dental, vision, and hearing continues to grow.
- The average monthly premium for a basic Medicare prescription drug plan in 2019 is projected to decrease by $1.09 (3.2 percent decrease) to an estimated $32.50 per month. The basic premium for an average Medicare prescription drug plan is projected to decline for a second year in a row.
Click HERE to read it straight from CMS.
Last week, I published an article titled “How to Bill Medicare for a Therapist Not Yet Credentialed“. This article then led to readers asking must physical therapists (PTs), occupational therapists (OTs), and speech-language pathologists (SLPs) in private practice enroll in the Medicare program if they want to treat Medicare beneficiaries? The answer is yes. PTs, OTs and SLPs in private practice must enroll in the Medicare program if they want to treat Medicare beneficiaries for services that would be covered by the Medicare program. In addition, once they enroll in the Medicare program, PTs, OTs and SLPs in private practices do not have the option to opt out if they want to treat Medicare beneficiaries for services that would be covered by the Medicare program. They must remain enrolled in the Medicare program.
This then leads to a second question I am often asked. If PTs, OT’s and SLPs in private practice must enroll in the Medicare program, what is this non-participating provider status? Doesn’t this mean I don’t participate with Medicare, hence, I can charge the Medicare beneficiary cash? The answer is no. In this article, I will explain the difference between being a participating provider or a nonparticipating provider with Medicare, which one you are automatically enrolled in when you become a Medicare provider unless you complete an additional form and the pros and cons of each.
Effective for dates of service on or after Oct. 1, 2018, the following procedure codes will require prior authorization for UnitedHealthcare Community Plan of Mississippi (Medicaid, CHIP Plans):
Speech Therapy: CPT Code 92507
The American Physical Therapy Association partnered with the American Chiropractic Association and presented an application for a dry needling CPT code at the American Medical Association CPT Meeting in Boston, September 27-29. APTA will provide an update on the results of the meeting after the meeting information is made public. Watch for an updated article on my website once the information is made public.