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04/26/21

Do Medicare Beneficiaries Have Unlimited Outpatient Therapy Benefits?

One of my Medicare patients called the Medicare program to ask them about outpatient therapy benefits and they were told that they have unlimited outpatient therapy benefits. Is that true? Let me provide the answer to that question below with the reference to support my answer. QuestionDo Medicare beneficiaries have unlimited outpatient therapy benefits? Answer I hope this article has assisted you in explaining outpatient therapy benefit coverage to your Medicare beneficiaries. Thank you for being a Gold Member!

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04/26/21

UnitedHealthcare Extends Telehealth Coverage for Their Medicare Advantage Plans

UnitedHealthcare (UHC) has announced they have once again extended coverage of outpatient physical, occupational and speech therapy services delivered via telehealth for their Medicare Advantage beneficiaries. UHC will cover all in-network and out-of-network outpatient therapy telehealth services as outlined Thank you for being a Gold Member!

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04/20/21

UHC Community Plan Revises SLP Coverage Determination Guideline

UnitedHealthcare (UHC) Community Plan has issued a revised Speech Language Pathology Services Coverage Determination Guideline (CDG). The effective date of this revised CDG is May 1, 2021 and only applies to the states of Arizona, California, Hawaii, Kansas, Maryland, Michigan, New York, Ohio, Pennsylvania, Rhode Island, Virginia, Washington, and Wisconsin. To access the revised policy, click I hope you found this article helpful. Thank you for being a Gold Member.

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04/19/21

Public Health Emergency Renewed Once Again

On April 15, 2021, Xavier Becerra, Secretary of Health and Human Services, renewed the Public Health Emergency (PHE) due to COVID-19. The PHE will now end at the end of the day on July 19, 2021. Due to this extension, the Centers for Medicare and Medicaid Services (CMS) will continue to reimburse for outpatient physical, occupational and speech therapy services delivered via telehealth until at least until the end of the day on July 19, 2021.

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04/19/21

Can Therapy Students Treat Medicare Advantage Patients?

On March 1, 2021, I published an article titled “Supervision Requirements of Therapy Students Under the Medicare Program“. This article specifically addressed traditional Medicare. Of course, that article then led to questions regarding the supervision requirements of therapy students treating Medicare Advantage patients and do the traditional Medicare supervision requirements apply to Medicare Advantage plans. In this article, I will answer that question. QuestionDo the traditional Medicare supervision requirements of therapy students also apply to Medicare Advantage plans and their respective beneficiaries? Answer I hope this answer has helped you. Thank you for being a Gold Member!

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04/17/21

UnitedHealthcare Commercial Reimbursement Policy Updates

Effective with dates of service on or after 9/1/2020, the Outpatient Hospital Correct Coding Initiative (CCI) Editing policy will apply to all network and non-network hospitals. In addition, the policy will apply to all outpatient types of bills that are applicable to these edits. Click HERE to read the announcement straight from UnitedHealthcare.

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04/14/21

House Passes Bill to Extend Sequestration Pause

On April 13, 2021, the United States House of Representatives passed H.R. 1868 which extends the pause on the 2% sequestration reduction through the end of calendar year 2021. This legislation was passed by the United States on March 25, 2021. President Biden signed this legislation into law on April 14, 2021.

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04/12/21

Is There a 2-Tiered Therapy Threshold for Medicare?

Ever since the Centers for Medicare and Medicaid Services (CMS) implemented the Targeted Medical Review process, providers of outpatient therapy services have referred to this as the “second cap”, the “second tier”, or the “second threshold” with the “first cap” or “first tier” being the annual therapy threshold (formerly called the therapy cap). In this article, I will answer common questions I receive on the annual therapy threshold and the targeted medical review and provide criteria on how claims may be selected for a targeted medical review. QuestionWhat is annual therapy threshold dollar amount for calendar year 2021? Answer QuestionIn

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