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02/09/20

UnitedHealthcare to Implement NCCI Edits

UnitedHealthcare (UHC) has announced they will implement the National Correct Coding Initiative (NCCI) edits to outpatient physical, occupational and speech therapy services effective with dates of service on and after I hope you found this article informative and will assist you in notifying your staff, billing company or billing department about this upcoming change that will impact your payment for outpatient therapy services if unaware of this change. Thank you for being a Gold Member!

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02/09/20

UnitedHealthcare Updates Multiple Therapy Procedure Therapy Reduction Policy

UnitedHealthcare (UHC) has updated their Multiple Therapy Procedure Therapy Reduction policy for physical, occupational and speech-language pathology therapy services provided in the private practice setting. To access the revised policy, click HERE. This policy applies to UHC Commercial Plans. I hope you enjoyed this free article.

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02/03/20

Aim Specialty Health Update

AIM Specialty Health has announced the launch dates for the AIM Rehabilitative program for Anthem’s Commercial Membership and Anthem’s Medicare Advantage Membership. This announcement impacts 2 states for Anthem’s Commercial Membership and 16 states for Anthem’s Medicare Advantage Membership. The AIM Rehabilitative program for Anthem’s Commercial Membership will relaunch April 1, 2020 for the states of The AIM Rehabilitative program for Anthem’s Medicare Advantage membership will launch April 1, 2020 and will impact the following states: I hope you found this article helpful. Thank you for being a Gold Member!

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01/24/20

Update on Evaluation and Therapeutic Activities Same Day

Breaking news from the Centers for Medicare and Medicaid Services (CMS) regarding the payment of a physical therapy evaluation and/or occupational therapy evaluation on the same day you bill therapeutic activities. Several professional organizations have received notice from Capital Bridge, LLC, National Correct Coding Initiative Contractor, announcing they will What About Group Therapy and an Evaluation on the Same Day? What About Manual Therapy and an Evaluation Same Day? I hope you found this information helpful. Thank you for being a Gold Member! 

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01/24/20

2018 MIPS Performance Data Released

The Centers for Medicare and Medicaid Services (CMS) has released the Merit-Based Incentive Payment System data for Performance Period 2018. The final 2018 performance feedback data revealed: 98% of eligible clinicians participated in MIPS in 2018— up from 95% in 2017 98% of eligible clinicians exceeded the performance threshold score of 15 points to receive a positive payment adjustment— up from 93% in 2017 356,353 clinicians participated in MIPS through APMs— up from 341,220 in 2017 Click HERE to read more about the 2018 MIPS Performance Period data.

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01/20/20

Billing 92611 and 74230 Same Day

The Centers for Medicare and Medicaid Services (CMS) have implemented National Correct Coding Initiative (NCCI) edits version 26.0. NCCI edits version 26.0 is in effect for dates of service January 1, 2020 – March 31, 2020. One significant change with this version involves a speech-language pathologist (SLP) and a radiologist collaborating to perform a motion fluoroscopic evaluation of swallowing function by cine or video recording (modified barium status study). Effective with NCCI version 26.0, CPT code 74230 (Radiologic examination, swallowing function, with cineradiography/videoradiography) will not be To access the current version of NCCI edits specific to outpatient therapy services, click

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01/20/20

Humana Issues 2 New Policies Impacting Outpatient Therapy

Humana has issued 2 new policies that have an impact on outpatient therapy services. Both policies apply to Humana Medicare Advantage plans and Humana Commercial plans. CQ/CO Modifier Effective with dates of service on and after Missed Appointments Humana’s Medicare Advantage and Commercial Payment Policies both allow a provider to bill I hope you enjoyed this article. Thank you for being a Gold Member!

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01/09/20

Billing Therapeutic Activities Same Day as an Evaluation

Effective with dates of service on and after January 1, 2020, the Centers for Medicare and Medicaid Services (CMS) will Question Is there a “work-around” to this issue? Answer Question Can I count the evaluation time under therapeutic activities? Answer Question Can I provide other treatments the same day as an evaluation? Answer Question Do these NCCI edits apply to all insurance carriers, including Medicare Advantage plans Answer Question Can any insurance carrier, Medicaid plan or Medicare Advantage plan implement the NCCI edits? Answer Question How do I know if an insurance carrier, Medicaid plan or Medicare Advantage plan has

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