I am receiving many questions regarding what is the proper billing when a patient is referred to either outpatient physical therapy or occupational therapy for the purpose of an orthosis. In this article, I will answer this question from 2 perspectives. I will first address when a patient is referred for a one-time visit for an orthosis and secondly, provide the answer for when a full evaluation is required to develop the appropriate treatment plan in addition to an assessment related to determining the specific orthosis required for the patient. First, we need to provide the CPT code and description

QuestionWhat are CPT codes 98960 – 98962? Answer QuestionWho can report these codes to the Medicare program or other insurance carriers? Answer QuestionDoes the Medicare program pay for CPT codes 98960 – 98962? Answer QuestionDo commercial and private insurance carriers pay for CPT codes 98960 – 98962? Answer I hope you found this article informative. Thank you for being a Gold Member!

Noridian Healthcare Solutions has a dedicated webpage that provides instructions how to view a beneficiary’s Medicare eligibility: Part A, Part B, Health Maintenance Organization (HMO) and Managed Care Organization (MCO), Medicare Secondary Payer (MSP), Home Health, Hospice, End Stage Renal Disease (ESRD), Preventive Services and Medicare Diabetes Prevention Program (MDPP). If Noridian is your Medicare Administrative Contractor, this is a valuable resource as Noridian also gives instructions regarding how to identify if a Medicare beneficiary is enrolled in the Qualified Medicare Beneficiary (QMB) program. To access the instructions, click HERE.

QuestionAm I allowed to collect a Medicare beneficiaries annual Part B deductible at the time of service if I know they have not yet met their deductible for the applicable calendar year? Answer I hope you found this article helpful and you now have a better understanding about collecting a Medicare beneficiaries deductible prior to the Medicare program paying the claim. Thank you for being a Gold Member!

A question I often receive is can a physical therapist (PT) student, physical therapist assistant (PTA) student, occupational therapist (OT), occupational therapy assistant (OTA) student or speech-language pathologist (SLP) student document in the medical record for a Medicare beneficiary receiving outpatient therapy services and if yes, what are the co-signature requirements? In this article, I will answer these 2 questions plus a third question applying it to Medicare Advantage and commercial insurance carriers. QuestionCan a PT student, PTA student, OT student, OTA student or SLP student document in the medical record for a Medicare beneficiary receiving outpatient therapy services? Answer

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?

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

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.