SNF Post Pay Audits to Begin

Skilled Nursing Facilities (SNFs) have been put on notice. On March 17, 2017, the Supplemental Medical Review Contractor (SMRC) announced the Centers for Medicare and Medicaid Services (CMS) has directed them to conduct a post-pay audit of SNF PPS claims. Per the SMRC, care in a SNF is covered if all of the following four factors…

CMS Pauses Pre-Claim Review Demonstration for Home Health Services

As of April 1, 2017, the Pre-Claim Review demonstration will be paused for at least 30 days in Illinois. The demonstration will not expand to Florida on April 1, 2017. After March 31, 2017, and continuing throughout the pause, the Medicare Administrative Contractors will not accept any Pre-Claim Review requests.  During the pause, home health claims can be submitted for payment and will be…

NCCI Edits Version 23.1 in Effect

The Centers for Medicare and Medicaid Services (CMS) has released the quarterly update of the National Correct Coding Initiative (NCCI) edits. NCCI Edit Version 23.1 is in effect for dates of service April 1, 2017 – June 30, 2017. NCCI edits are used by CMS in the outpatient therapy realm in all practice settings including…

CMS Releases Revised ABN Form

The Advance Beneficiary Notice of Noncoverage (ABN), Form CMS-R-131, and form instructions have been approved by the Office of Management and Budget (OMB) for renewal. In accordance with Section 504 of the Rehabilitation Act of 1973 (Section 504), the form has been revised to include language informing beneficiaries of their rights to CMS nondiscrimination practices…

Pediatric Alternative Payment Model

The CMS Innovation Center, in partnership with the Center for Medicaid and Chip Services (CMCS), is releasing a Request for Information (RFI) seeking input on the design of alternative payment models focused on improving the health of children and youth covered by Medicaid and Children’s Health Insurance Program (CHIP). CMS states “through the RFI, input…

When Do I Have to Report G-Codes

Functional Limitation Reporting (FLR) (i.e. G-codes) has been required for dates of service on and after July 1, 2013 for Medicare beneficiaries receiving outpatient therapy services being billed under their Part B Medicare benefits. I still receive many questions when G-codes have to be reported on the claim form. Many of the questions I receive…

Comparative Billing Reports Released

eGlobalTech (EGT) and Palmetto GBA have developed and disseminated a national provider Comparative Billing Report (CBR) in February 2017 on physical therapy services provided by physical therapists in private practice. The report contains data-driven tables with an explanation of findings that compare these providers’ billing and payment patterns to those of their peers in their state…