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! 

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.

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

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!

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

Every quarter, the Centers for Medicare and Medicaid Services (CMS) updates the National Correct Coding Initiative (NCCI) edits. This occurs on January 1st, April 1st, July 1st and October 1st of every year. The biggest changes usually occur with the January 1st edition due to new and deleted CPT codes for the new calendar year now being in effect. Version 26.0 has been released by CMS. This version will be effective with dates of service beginning on January 1, 2020 through March 31, 2020. There are many additions and deletions to Version 26.0 that will have a significant impact on

For calendar year 2020, physical therapists, occupational therapists and speech-language pathologists will once again be considered Merit-Based Incentive Payment System (MIPS) eligible clinicians. In this article, I will answer some of the more frequent questions I receive about the MIPS program as they relate to the Quality Performance Measures. Question #1 In Performance Period 2020, how many quality measures must physical therapists, occupational therapists and speech-language pathologists report? Answer #1 Question #2 How is the 70% data completeness calculated? Answer #2 Question #3 In Performance Period 2020, how are quality measures scored? Answer #3 Question #4 In Performance Year 2020,

For calendar year 2020, physical therapists, occupational therapists and speech-language pathologists will once again be considered Merit-Based Incentive Payment System (MIPS) eligible clinicians. In this article, I will answer some of the more frequent questions I receive about the MIPS program. Question #1 What practice setting(s) does MIPS apply to? Answer #1 Question #2 Is there an easy way to know if I am a private practice with the Medicare program? Answer #2 Question #3 Does MIPS apply to Rehabilitation Agencies? Answer #3 Question #4 What is the determination period that CMS will use to see if an eligible clinician