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01/18/21

Qualified Medicare Beneficiary Program

Lately, I have been receiving questions regarding Medicare beneficiaries who are dually eligible (have Medicare primary and Medicaid secondary) and are enrolled in the Qualified Medicare Beneficiary (QMB) program. Medicare beneficiaries enrolled in the QMB program are also enrolled in Medicaid and get help with their Medicare premiums and cost-sharing. What providers want to know is can they bill the Medicare beneficiary who is enrolled in the QMB program for the 20% co-insurance the Medicare program does not cover as well as any deductible the Medicare beneficiary has not met yet if the Medicaid program does not pay that portion?

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01/07/21

Secretary Azar Extends PHE

On January 7, 2021, Secretary Azar renewed the Public Health Emergency (PHE) due to COVID-19 effective January 21, 2021. The new expiration date of the PHE is April 20, 2021. Click HERE to read the announcement. What does the extension of the PHE mean for outpatient physical, occupational and speech therapy services? It means that the Medicare program will continue to pay providers for outpatient therapy services delivered via telehealth until the end of the PHE, which is now scheduled to end on April 20, 2021. This extension includes private practices and facility-based settings. I will be providing a webinar

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01/06/21

Independent Contractor Status under the Fair Labor Standards Act

On January 6, 2021, the Department of Labor announced a final rule clarifying the standard for employee versus independent contractor under the Fair Labor Standards Act (FLSA). The effective date of the final rule is March 8, 2021. The final rule will be published in the Federal Register on January 7, 2021. Click HERE for additional information.

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01/06/21

CMS Publishes 2021 MPFS Conversion Factor

On January 5, 2021, the Centers for Medicare and Medicaid Services (CMS) published the revised conversion factor (CF) for services reimbursed under the Medicare Physician Fee Schedule (MPFS) for calendar year 2021. This would include outpatient therapy services provided in all outpatient therapy settings except for critical access hospitals since critical access hospitals are not reimbursed under the MPFS. The revised 2021 CF for services paid under the MPFS is In addition, I have created an excel spreadsheet that provides the Medicare allowed amount for the most common CPT codes billed by physical, occupational and speech therapy for calendar year

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01/04/21

Aetna Telehealth Update: January 2021

Aetna has announced they have extended their coverage of telehealth services for physical, occupational and speech therapy for their Commercial and Medicare Advantage plans. The extended coverage end date is I hope you found this information helpful. Thank you for being a Gold Member!

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01/04/21

UnitedHealthcare Telehealth Update: January 2021

On January 1, 2021, outpatient physical, occupational and speech therapy services provided via telehealth for UnitedHealthcare (UHC) commercial plans will be changing and there will be a difference in telehealth coverage between providers who submit claims on a 1500-claim form and providers who submit claims on a UB-04 claim form. QuestionWhat is changing on January 1, 2021 for UHC Commercial plans? Answer QuestionWhat place of service (POS) code is to be used on the claim form for an outpatient therapy visit conducted via telehealth? Answer QuestionWhat is changing on January 1, 2021 for UHC Medicare Advantage plans? Answer

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01/04/21

Cigna Telehealth Update: January 2021

On January 1, 2021, outpatient therapy services provided via telehealth for Cigna beneficiaries will be changing and there will be a difference in telehealth coverage between providers who submit claims on a 1500-claim form and providers who submit claims on a UB-04 claim form once the public health emergency is declared over. To read about the changes concerning Cigna and outpatient therapy services provided via telehealth, click HERE. I hope you found this article helpful. Thank you for being a Gold Member!

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12/30/20

Quality Measure Changes for Registry Reporting in 2021

The Centers for Medicare and Medicaid Services (CMS) has released the 2021 Medicare Part B Registry Quality Measure specifications and supporting documents. This release provides comprehensive descriptions of the 2021 registry Quality Measures for the Merit-based Incentive Payment System (MIPS) Quality Performance Category. In this article, I will highlight the 2021 significant changes for each Quality Measure that can be reported via a registry by physical therapists (PTs), occupational therapists (OTs) and speech-language pathologists (SLPs) as well as list the denominator criteria for each Quality Measure that can be reported via a registry as it applies to PTs, OTs, and

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