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11/11/19

Medicare 2020 Deductibles and Premiums Announced

The Centers for Medicare and Medicaid Services (CMS) has announced the 2020 Medicare Part A and Part B premiums and deductibles. In this article, I will provide you with what the premiums and deductibles are for 2020 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. Question What is the 2020 Medicare Part B deductible? Answer Question How does the Part B deductible impact the annual therapy threshold dollar amount? Answer Question What is the

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11/11/19

Important Medicare Supplement Plan Changes for 2020

Big changes are coming in calendar year 2020 for Medicare beneficiaries who purchase Medicare Supplement plans (known as Medigap). The changes are a result of the Medicare Access and CHIP Reauthorization Act (MACRA) that will change Medicare Supplement plans in all states, and this becomes effective January 1, 2020. Who will this change impact in calendar year 2020? The changes will effect ONLY newly eligible Medicare beneficiaries. Newly eligible is defined as “people who are 65 years of age or become first eligible for Medicare because of age, disability or end-stage renal sickness on or after January 1, 2020”. Why

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11/04/19

Will CMS Pay for Dry Needling in 2020

On January 1, 2020, there will be 2 new CPT codes to report needle insertion(s) (i.e. dry needling) for qualified healthcare professionals, such as physical therapists, who provide dry needling where allowed by state law and state practice act. Now, just because we have the new CPT codes that describe dry needling does not mean the Medicare program and other insurance carriers have to pay for them. In this article, I will provide the 2 new CPT codes and also tell you if the Medicare program is going to pay for the codes. The 2 new CPT codes that describe

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11/01/19

CMS Releases 2020 Final Rule for Medicare Services

On November 1, 2019, the Centers for Medicare and Medicaid Services (CMS) released the final rule for services paid under the Medicare Physician Fee Schedule (MPFS) and the Merit-Based Incentive Payment System (MIPS) program for calendar year (CY) 2020. Highlights of the final rule include, but are not limited to, the following: 2020 Medicare Conversion Factor 2020 Annual Therapy Threshold Dollar Amount Dry Needling CPT Codes CO/CQ Documentation Requirements New PTA and OTA Modifiers Effective January 1, 2020 Discipline Specific Therapy Modifiers (GO and GN) Biofeedback CPT Codes Cognitive Function Interventions Negative Pressure Wound Therapy Here we go! 2020 Conversion

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11/01/19

CMS Releases 2020 Home Health Final Rule

On October 31, 2019, the Centers for Medicare and Medicaid Services (CMS) issued the final rule for Home Health Agencies for calendar year 2020. Highlights of the final rule include: CMS projects that aggregate Medicare payments to HHAs in CY 2020 will increase by 1.3 percent, or $250 million CMS will allow physical therapist assistants and occupational therapy assistants to provide maintenance therapy Home health episode of care will decrease for a 60-day episode to a 30-day episode Beginning in 2021, CMS will require HHAs to submit a notification to CMS within 5 calendar days from the start of care

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10/30/19

BCBS of Minnesota Reviewing for Medical Necessity

On June 3, 2019, Blue Cross and Blue Shield (BCBS) of Minnesota removed the prior authorization (PA) requirements for outpatient therapies, including physical, occupational, and speech therapy, and chiropractic services. Self-Insured Groups may have benefits that require a PA for outpatient therapy or chiropractic services. These services may be managed as a PA or a retrospective review. While the above is good news, with the removal of the PA, BCBS of Minnesota will be conducting medical necessity review of services. The number of visits outlined below provides an example of when Blue Cross would typically begin reviewing therapies for medical

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10/27/19

UnitedHealthcare Medicare Advantage Plan Changes

Since January 1, 2019, facilities that provide post-acute care inpatient services have been required to request prior authorization and receive a pre-service determination before UnitedHealthcare (UHC) Medicare Advantage Plan members can be admitted to a post-acute care facility or a post-acute care bed in one of the following types of facilities: Acute Inpatient Rehabilitation Skilled Nursing Facilities Long-term Acute Care Hospitals Critical Access Hospitals that provide post-acute services Beginning on October 1, 2019, UHC will

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10/24/19

Medicare Spending for Outpatient Therapy in 2017

The Medicare Payment Advisory Commission (MedPAC) has released a 3-page document providing data and Medicare spending for outpatient therapy in calendar year 2017. Here is a brief summary of the report. Distribution of Outpatient Therapy by Setting Skilled Nursing Facility: 37% PT in Private Practice: 34% Hospital: 16% ORF, CORF and HHA: 9% OT & SLP Private Practice: 3% Physician & Nonphysician Practitioner: 2% Keep in mind that PT in private practice can include physical therapists who practice in a physician-owned therapy practice, but are submitting claims under the NPI number of the treating physical therapist. Spending by Discipline In

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