Major Joint Replacement Booklet

The Centers for Medicare & Medicaid Services (CMS) has had multiple auditing entities, including the Recovery Auditors, Comprehensive Error Rate Testing (CERT) Contractors, and Medicare Administrative Contractors (MACs) review claims for total major joint replacements such as hips and knees. Their findings have demonstrated very high paid claim error rates among both hospital and professional…

Humana Updates Preauthorization Requirements for Therapy Services

Humana will no longer require preauthorization for outpatient physical, speech and occupational therapy services for patients with commercial and Medicare Advantage (MA) coverage, effective Dec. 18, 2017. Following are some important details about this change: While preauthorization will no longer be required, visit limits and other plan provisions (e.g., referrals) will still apply. Referrals should…

Start of a New Year

With the beginning of a New Year, I often receive the following questions regarding patients that were being seen for outpatient therapy in December and continue to receive therapy in January of the new year: Do I need to perform and bill for an evaluation or reevaluation on the patient’s first visit in January? Do…