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05/27/21

Complying with Medicare Signature Requirements

Do you have questions concerning signature requirements under the Medicare program? If yes, I recommend you click HERE and read the March 2021 MLN Fact Sheet on Medicare signature requirements.

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05/27/21

Medical Record Maintenance & Access Requirements

The Centers for Medicare and Medicaid Services (CMS) has issued a new MLN Fact Sheet that educates Medicare physicians, nonphysician practitioners, hospitals, other providers, and suppliers on the updated regulations at 42 Code of Federal Regulations. This fact sheet provides information on the following: Who does the updated regulation impact? Who may request access to these medical records? What type of documentation must you maintain and provide to CMS or one of their Medicare contractors? What happens if you don’t maintain required documentation or don’t provide access? To access this fact sheet, click

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05/24/21

How Many Timed Units Can I Bill In An Hour?

A question I am often asked is how many 15-minute time-based units can I bill in an hour? Or phrased another way, I can only bill 4 15-minute time-based units in an hour, correct? The simple answer is that it’s possible to bill more than 4 15-minute time-based units in an hour, even if you had an all Medicare outpatient therapy population. In this article, I will provide examples of how it’s possible to bill more than 4 15-minute time-based units in an hour for both Medicare patients and commercial insurance patients just using one therapist or one therapist/therapy assistant

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05/18/21

CMS Extends Hip and Knee Bundled Payment Program

On April 29, 2021, the Centers for Medicare and Medicaid Services (CMS) issued a final rule extending the Comprehensive Care for Joint Replacement model through December 31, 2024 for the 34 metropolitan statistical areas (MSAs) in which participation was mandatory. Hospitals participating in the “voluntary” MSAs, as well as all low-volume and rural hospitals that have elected to participate, will continue to see the model end on Sept. 31, 2021. To access the final rule, click HERE.

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05/17/21

Anthem BC Requires Modifiers on Outpatient Therapy Claims

Anthem BC has revised their policy concerning modifiers that are required on outpatient physical, occupational and speech therapy claims. Failure to append the applicable modifier will result in nonpayment of your claim. Anthem BC services the following states: California Colorado Connecticut Georgia Indiana Kentucky Maine Missouri New Hampshire Nevada New York Ohio Virginia Wisconsin To access the policy, click I hope you found this article helpful. Thank you for being a Gold Member!

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05/17/21

UnitedHealthcare and OptumHealth Care Solutions Therapy Policies

I receive many questions regarding how to locate outpatient therapy policies for UnitedHealthcare (UHC) and OptumHealth Care Solutions (Optum). In this article, I will provide links to the most common outpatient physical, occupational and speech therapy policies for UHC and Optum. UHC Reimbursement Policies for Outpatient Therapy Services Optum Reimbursement Policies for Outpatient Therapy Services I hope you found this article helpful and you utilize all of the outpatient therapy policies in this article. Thank you for being a Gold Member!

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05/11/21

Palmetto Did Not Apply MPPR on All Therapy Claims

Palmetto GBA has announced that some skilled nursing facility (SNF) type of bills (TOB) 22X and 23X and Critical Access Hospital (CAH) TOB 85x with dates of service January 1 through April 11, 2021, processed prior to April 12, 2021, did not have the Multiple Procedure Payment Reduction (MPPR) applied on them. The system was updated on April 12, 2021, when the fix was installed. These TOBs with Revenue Code 042X, 043X or 044X present with more than 1 units or Revenue Code 042X, 043X or 044X present on more than one line with the same line item date of service, are

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05/10/21

UHC Community Plan Medicaid Covered and Non-Covered CPT Codes

UnitedHealthcare Community Plan has published 2 Reimbursement Policies, one for providers who submit claims on a 1500-claim form (Professional) and one for providers who submit claims on a UB-04 claim form (Facility). The policies list which CPT codes are and are not covered by the different state’s Medicaid program. To access the policy for providers who submit claims on a 1500-claim form, click To access the policy for providers who submit claims on a UB-04 claim form, click I hope you found this article helpful to your practice or organization. Thank you for being a Gold Member!

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