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11/01/23

CMS Finalizes Lymphedema Coverage Guidelines and Payments

Due to passage of the Consolidated Appropriations Act, 2023, the Centers for Medicare and Medicaid Services (CMS) will begin to reimburse for lymphedema standard and custom fitted gradient compression garments and other items as determined by the Secretary of Health and Human Services (HHS) beginning January 1, 2024. On November 1, 2023, CMS released the calendar year (CY) 2024 Home Health Prospective Payment System final rule. In this final rule, CMS finalized the following regarding lymphedema compression treatment items:

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10/30/23

Aetna Updates Implementation of Assistant Payment Reduction

Aetna has revised the effective date of their implementation to reduce payment when outpatient therapy services are provided in whole or in part by a physical therapist assistant or an occupational therapy assistant. Click HERE to read the updated article with the new effective date.

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10/23/23

Speech Therapy Billing Scenarios: Part 2

In this article, I will provide the answers to the following speech therapy billing scenarios:

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10/23/23

Amount in Controversy for Appeals in 2024

The Centers for Medicare and Medicaid Services (CMS) has announced the dollar amount that must remain in controversy in 2024 in order to appeal to the Administrative Law Judge (ALJ) or the Federal District Court. In this article, I will answer the following questions:

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10/16/23

Medicare 2024 Deductibles and Premiums Announced

The Centers for Medicare and Medicaid Services (CMS) has announced the 2024 Medicare Part A and Part B premiums and deductibles. In this article, I will provide you with what the premiums and deductibles are for 2024 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. In this article, I will answer the following questions:

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10/09/23

Speech Therapy Billing Scenarios: Part 1

In this article, I will provide the answers to the following speech therapy billing scenarios:

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10/02/23

Aetna Announces the End of Some Telemedicine Services

Aetna has announced they will no longer reimburse for some telemedicine services. In this article, I will answer the following questions:

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10/02/23

Federal Independent Dispute Resolution (IDR) Process Administrative Fee and Certified IDR Entity Fee Ranges

The Department of the Treasury, Department of Labor, and Department of Health and Human Services have issued a proposed rule related to the fees established by the No Surprises Act for the Federal independent dispute resolution (IDR) process, as established by the Consolidated Appropriations Act,2021 (CAA). This proposed rule could have implications for outpatient physical, occupational and speech therapy services for patients who are paying cash and you end up charging them more than $400 of what was listed in the Good faith Estimate (GFE) that you provided to them. In this article, I will answer the following questions:

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