If you are a Blue Cross Blue Shield (BCBS) provider in the state of Michigan and provide outpatient therapy services, you will want to read this article. eviCore Healthcare has made changes to the corePath therapy authorization model for initial authorization requests for new episodes of treatment. This change applies to: Physical therapy providers in categories B and C Occupational therapists in category B What Has Changed? To access a nice 6-page document that contains frequently asked questions (FAQs) regarding practitioner performance summary and provider category FAQs, click I hope you found this article helpful and informative. Thank you for being

On August 17, 2020, the Centers for Medicare and Medicaid (CMS) announced they will resume routine inspections of all Medicare- and Medicaid-certified providers and suppliers that were previously suspended as part of its response to the COVID-19 pandemic. To read the notice straight from CMS, click HERE.

On August 4, 2020, the Centers for Medicare and Medicaid Services (CMS) released the calendar year (CY) 2021 proposed rule titled “Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs; New Categories for Hospital Outpatient Department Prior Authorization Process; Clinical Laboratory Fee Schedule: Laboratory Date of Service Policy; Overall Hospital Quality Star Rating Methodology; and Physician-owned Hospitals.“ Highlights of the proposed rule include: CMS is proposing to eliminate the Inpatient Only (IPO) list over a three-year transitional period with the list completely phased out by CY 2024 CMS is proposing to expand the

On August 4, 2020, the Centers for Medicare and Medicaid Services (CMS) released the fiscal year (FY) 2021 Final Rule for Inpatient Rehabilitation Facilities (IRFs). Highlights of the final rule include: Permanent elimination of the post-admission physician evaluation effective October 1, 2020 CMS is finalizing that a non-physician practitioner (NPP) may perform one of the three required visits in lieu of the physician in the second and later weeks of a patient’s care, when consistent with the NPP’s state scope of practice Overall IRF payment update for FY 2021 of 2.8% To access the Final Rule, click HERE. To access

The Centers for Medicare and Medicaid Services has released the calendar year (CY) 2021 proposed rule for services paid under the Medicare Physician Fee Schedule and the Quality Payment Program that includes the Merit-Based Incentive Payment System (MIPS). In this article, I will provide a summary of the proposed MIPS 2021 program and 2021 Performance Period. MIPS Value Pathways (MVPs) 2021 MIPS Participation Options 2021 Performance Threshold 2021 Performance Category Weights CMS Web Interface Reporting Option Complex Patient Bonus COVID-19 Update in 2020 2021 Quality Measures Proposed Quality Measure Additions to the PT & OT Specialty Set Proposed Quality Measure

The Centers for Medicare and Medicaid Services (CMS) has released the calendar year (CY) 2021 Proposed Rule for services paid under the Medicare Physician Fee Schedule (MPFS). This would include outpatient physical, occupational and speech therapy services provided in all settings (private practice (both therapist-owned and physician-owned, skilled nursing facilities doing Part B, comprehensive outpatient rehabilitation facilities, rehabilitation agencies, home health agencies providing Part B therapy services in the home and hospital outpatient therapy departments). This proposed rule would not apply to outpatient therapy services provided by critical access hospitals (CAHs) since CAHs are not reimbursed under the MPFS. Highlights

The Centers for Medicare and Medicaid Services (CMS) has released ICD-10-CM for Fiscal Year (FY) 2021 on their website. These 2021 ICD-10-CM codes are to be used for discharges occurring from October 1, 2020 through September 30, 2021 and for patient encounters occurring from October 1, 2020 through September 30, 2021. To access the FY 2021 ICD-10-CM new, revised and deleted ICD-10-CM codes effective October 1, 2020, click HERE. To access the files from the CMS website, click HERE.

This article was updated on August 3, 2020 as CMS did change the effective date. Per the Centers for Medicare and Medicaid Services, 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. The use of the renewed form with the expiration date of 06/30/2023 will be mandatory on I hope you found this article helpful. Thank you for being a Gold Member!