Are You Having Issues With Humana

Private practices and facilities (skilled nursing facilities, rehab agencies and hospitals) are reporting difficulty getting paid for outpatient therapy claims with Humana’s commercial and Medicare Advantage insurance plans. The American Physical Therapy Association (APTA) has received many complaints from their members regarding the retroactive application of the multiple procedure payment reduction (MPPR), further reductions to in-network…

NCCI Edits Version 23.3 Released

The Centers for Medicare and Medicaid Services has released the National Correct Coding Initiative (NCCI) Version 23.3 edits. Version 23.3 is in effect for dates of services October 1 – December 31, 2017.     Gawenda Seminars & Consulting has created a “cheat sheet” for the use of modifier 59 in outpatient therapy. This “cheat…

Special Requirements for Therapists Who Provide Orthotics

On January 12, 2017, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule which would specify the qualifications needed for qualified practitioners to furnish and fabricate, and qualified suppliers to fabricate prosthetics and custom- fabricated orthotics; accreditation requirements that qualified suppliers must meet in order to bill for prosthetics and custom-fabricated orthotics;…

2018 CPT Code Changes

The 2018 CPT codes have been officially released by the American Medical Association (AMA) and there are several changes that will impact outpatient physical and occupational therapy services. CPT codes, description, and material are copyright 2017 AMA. CPT is a trademark of the AMA. 2018 CPT code changes impact the following CPT codes:  Multi-layer compression…

TRICARE Changes Coming in 2018

The Military Health System (MHS) is modernizing TRICARE to better serve its members and respond to changes in law and policy. Most provisions will go into effect on January 1, 2018, with full implementation occurring on January 1, 2019. Changes will impact TRICARE health plans, changes to the 3 TRICARE Regions and new regional contractors…