Current News

News

03/09/20

UnitedHealthcare Medicare Advantage Updates Speech Generating Devices Coverage Summary

UnitedHealthcare Medicare Advantage has updated their coverage summary for speech generating devices with an effective date of February 18, 2020. To access the updated clinical policy, click HERE. Thank you for being a Gold Member!

Read More
03/03/20

CMS Hip and Knee Bundled Payment Program

On February 20, 2020, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule revising certain aspects of the Comprehensive Care for Joint Replacement (CJR) model including the episode of care definition, the target price calculation, the reconciliation process, the beneficiary notice requirements and the appeals process. CMS is proposing to extend the CJR model for an additional three years, through Dec. 31, 2023, but only to hospitals in the 34 metropolitan statistical areas in which participation was mandatory. Hospitals participating in the 33 “voluntary” MSAs, as well as all low-volume and rural hospitals that have elected to

Read More
03/02/20

Double Booking Non-Medicare Patients: How Do I Bill?

Two weeks, I wrote an article titled “Can I Double Book Medicare Patients“. If you have not had a chance to read this article, I would suggest you take a few minutes to read it as it will really help you in your practice and organization understand the rules and regulations regarding scheduling and billing of double booking Medicare patients. This article then led to other questions that I will address in this article. The last question will show you how it’s possible to bill 7 time-based units plus 2 untimed CPT codes within a one hour time period. QuestionCan

Read More
02/24/20

Humana Resumes Prior Authorization for Outpatient Therapy

On December 18, 2017, Humana announced they would no longer require preauthorization for outpatient physical, speech and occupational therapy services for patients with commercial and Medicare Advantage (MA) coverage. Unfortunately, nothing lasts forever. Effective with dates of service on and after I hope you found this article helpful and informative. Thank you for being a Gold Member!

Read More
02/24/20

Billing CPT Codes 92611 and 74230 Same Day: Update

The Centers for Medicare and Medicaid Services (CMS) and Capital Bridge, LLC, who is the National Correct Coding Initiative (NCCI) contractor, has informed the American Speech-Language-Hearing Association (ASHA) that they will change the modifier indicator for when CPT codes 92611 (Motion fluoroscopic evaluation of swallowing function by cine or video recording) and 74230 (Radiologic examination, swallowing function, with cineradiography/videoradiography) are billed on the same date of service by the same provider. CMS will now assign a modifier indicator ofI hope you found this article informative. Thank you for being a Gold Member!

Read More
02/20/20

Therapy Under the Home Health Patient-Driven Groupings Model

The Centers for Medicare and Medicaid Services has released a MLN Matters article that provides information on the continuing role of therapy under the newly implemented home health prospective payment system (HH PPS) case-mix adjustment methodology, named the Patient-Driven Groupings Model (PDGM), for home health periods of care starting on and after January 1, 2020. To access the article, click HERE. I hope you fond this article helpful.

Read More
02/18/20

Can Dry Needling Be Billed as Electrical Stimulation?

Since in calendar year 2020, the Centers for Medicare and Medicaid Services has decided that the new 2 dry needling CPT codes are non-covered, physical therapists want to know if there are other CPT codes that could possibly be billed instead and be paid by the Medicare program and other insurance carriers if performing needle insertion. QuestionIf I provide electrical stimulation through the needles, can I bill for this as unattended electrical stimulation or manual electrical stimulation? AnswerThe simple and straightforward answer is For additional information on dry needling, read “Will CMS Pay for Dry Needling in 2020” and also

Read More
02/17/20

Can I Double Book Medicare Patients?

Previously, I wrote an article explaining how much time of a time-based CPT code must be provided in order to bill that CPT code to an insurance carrier as well as explaining the difference between Medicare’s “8-minute rule” and the American Medical Association (AMA) definition of substantial when billing a time-based CPT code. This article then led people to ask me if I can double book and/or overlap Medicare patients receiving outpatient therapy services. I’m going to answer this question once and for all and the answer will not only apply to outpatient therapy services paid under Medicare Part B benefits, but

Read More