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11/09/20

Medicare 2021 Deductibles and Premiums Announced

The Centers for Medicare and Medicaid Services (CMS) has announced the 2021 Medicare Part A and Part B premiums and deductibles. In this article, I will provide you with what the premiums and deductibles are for 2021 and how the Medicare beneficiaries Part B deductible can impact the annual therapy threshold dollar amount dependent upon was the deductible met before or after they received outpatient physical, occupational and/or speech therapy services. Question What is the 2021 Medicare Part B deductible? Answer Question How does the Part B deductible impact the annual therapy threshold dollar amount? Answer Question What is the

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11/05/20

CMS Makes Payment Decision Regarding 99072

On September 8, 2020, the American Medical Association released CPT code 99072 and this code became effective immediately. I have previously published 2 articles on this CPT code. The first was on September 22, 2020 titled “CPT Code 99072: Can Therapists Bill This Code“? and the second was published on October 12, 2020 and titled “CPT Code 99072: Things to Think About“. At the time both articles were published, the Centers for Medicare and Medicaid Services (CMS) had not made a determination yet on whether they would pay for this CPT code. Well now, CMS has made that decision. CMS

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11/02/20

MIPS 2021 Payment Update

The Centers for Medicare and Medicaid Services has published updated data concerning the 2019 Merit-Based Incentive Payment System (MIPS) Performance Period results that will impact your calendar year 2021 Medicare payments for outpatient therapy services. Many MIPS eligible professionals who successfully participated in MIPS in 2019 and scored 30 or more points will be disappointed to learn that their positive payment adjustment won’t be that much, if anything at all. Here are the results: I hope you found this article helpful. If you will be participating in MIPS or are considering participating in MIPS in 2021, consider registering for my

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10/29/20

TRICARE Updates LBP and Physical Therapy Demonstration

TRICARE has provided updated information regarding their low back pain (LBP) and physical therapy demonstration scheduled to begin on January 1, 2021. Updated information includes the following: Demonstration goals and evaluation Policy and beneficiary eligibility ICD-10-CM Diagnosis codes applicable to demonstration Exclusions to the demonstration Under Policy and Beneficiary Eligibility, TRICARE states the following: I hope you found this article helpful. Thank you for being a Gold Member!

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10/22/20

Cigna Announces 2021 Virtual Care Reimbursement Policy

Cigna has announced their Virtual Care Reimbursement Policy for calendar year 2021. This announcement only applies to services provided to commercial medical customers, including those with Individual & Family Plans (IFP). Cigna Behavioral Health and Cigna Medicare Advantage customers continue to have covered virtual care services through their own separate benefit plans. In this article, I will answer the following questions: What practice setting(s) does this policy apply to? What Place of Service (POS) code do I use on the claim form? What CPT codes can be reimbursed if provided via telehealth (virtual care)? What modifier(s) must be appended to

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10/22/20

Therapy Evaluations Not Paid in Emergency Department

Over the past 2 weeks, I have been receiving emails from hospital therapy directors and billing departments stating they are no longer being paid for a physical therapy or occupational therapy evaluation or reevaluation when performed on a Medicare beneficiary who presents to their emergency department. In this article, I will explain why this is occurring. Effective with dates of service on and after I hope you found this article informative and helpful. Thank you for being a Gold Member!

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10/19/20

Can a Resident Certify a Therapy Plan of Care

QuestionCan a resident physician certify and recertify a plan of care for outpatient therapy services under the Medicare program? Answer If you have other questions about Medicare Part B and outpatient therapy plans of care, click HERE. If you have questions about Medicare Part B outpatient therapy certifications and recertifications, click Here.

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10/13/20

Current Supervision Requirements of an Assistant

In the private practice setting, the Centers for Medicare and Medicaid Services (CMS) requires that the physical therapist (PT) provide direct supervision of the physical therapist assistant (PTA) and that the occupational therapist (OT) provide direct supervision of the occupational therapy assistant (OTA) when the PTA and OTA are furnishing covered services to a Medicare beneficiary receiving outpatient physical or occupational therapy services, respectively. This means the supervising PT or OT must be present in the office suite at the time the service(s) is provided by the PTA or OTA to the Medicare beneficiary. What providers want to know is

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