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11/01/21

Understanding Medicare’s Multiple Procedure Payment Reduction Policy

On January 1, 2011, the Centers for Medicare and Medicaid Services implemented the multiple procedure payment reduction (MPPR) policy to outpatient physical, occupational and speech therapy services as well as other ancillary services. The purpose of MPPR is to reduce Medicare’s cost for these services. Even though MPPR has been around for 10 years, many therapists, office managers, billers, billing companies, practice owners, and financial analysts do not understand MPPR as it applies to outpatient therapy services. In this article, I will answer the following questions: What outpatient therapy settings does the MPPR policy apply to? Does the MPPR policy

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10/29/21

UHC Medicare Advantage Telehealth Update: October 2021

On October 15, 2021, UnitedHealthcare (UHC) I hope you found this article informative. 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 as your own material without prior written approval of Gawenda Seminars & Consulting, Inc.

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10/25/21

New and Revised Place of Service Codes for Telehealth

Effective January 1, 2022, there will be a new additional Place of Service (POS) code for telehealth and the current descriptor for the current POS code for telehealth has been changed. QuestionWhat is the new POS code for telehealth? Answer QuestionWhat is the descriptor for the new telehealth POS code? Answer QuestionWill CMS reimburse for telehealth services when billed using the new POS code? Answer QuestionWhat is the current POS code for telehealth and what is the revised descriptor for this POS code? Answer QuestionDuring the time that the Medicare program is paying for outpatient therapy delivered via telehealth due

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10/18/21

Does CMS Require an Order for Outpatient Therapy

There is a myth that the Medicare program requires a physician order that will then allow the Medicare beneficiary to begin and/or continue outpatient physical, occupational and/or speech therapy services. Why do I say this is a myth? Lets find out. QuestionDoes the Centers for Medicare and Medicaid Services (CMS) require a physician order for outpatient therapy? Answer QuestionWhy might it be beneficial for a Medicare beneficiary to have an order prior to beginning outpatient physical, occupational and/or speech therapy services? Answer QuestionIs there another reason an order might be beneficial for a Medicare beneficiary to have an order prior

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10/15/21

COVID Public Health Emergency Extended Again

On October 15, 2021, 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 January 15, 2022.

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10/11/21

Billing for Progress Reports

I question I am often asked is how do I bill for the time it takes me to assess a patient (both subjectively and objectively), analyze and interpret the data I collected, and write the Progress Report that is required by the traditional Medicare program, some commercial insurance carriers and some state practice acts? In this article, I will answer the following questions: Question #1When completing a Progress Report, what CPT code do I bill? Answer #1 Question #2How do I account for the time it takes me to assess a patient, gather subjective comments and objective data, analyze and

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10/04/21

UHC Community Plan Revises Outpatient Speech, Occupational and Physical Therapy Utilization Review Guidelines

UnitedHealthcare (UHC) Community plan has revised their Outpatient Speech, Occupational and Physical Therapy Utilization Review Guidelines. QuestionWhat is the effective date of the revised policy? Answer QuestionWhat state(s) does the revised policy apply to? Answer QuestionWhat are some of the topics discussed in the policy? Answer QuestionHow can I access the policy? Answer I hope you found this article informative and helpful. 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 as your own material without prior written approval of

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10/04/21

UHC Community Plan Revises SLP Coverage Determination Guideline

UnitedHealthcare (UHC) Community Plan has revised their Speech Language Pathology Services Coverage Determination Guideline. QuestionWhat is the effective date of the revised policy? Answer QuestionWhat state(s) does the revised policy apply to? Answer QuestionWhat are some of the topics discussed in the policy? Answer QuestionHow can I access the revised policy? Answer I hope you found this article informative and helpful. 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 as your own material without prior written approval of Gawenda

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