On May 23, 2019, House Bill (HB) 29 passed the Texas Senate and on June 14, 2019, Governor signed the bill into law. HB 29 will provide Texas residents the ability to have Direct Access for physical therapy services with an effective date of September 1, 2019. Highlights of HB 29 and Direct Access include: A physical therapist may treat a patient for an injury or condition in a manner described by Section 453.005 without a referral if the physical therapist:  

UnitedHealthcare (UHC) has announced they have delayed the implementation of therapy specific modifiers (GN, GO, GP) to allow providers more time to adjust to changes in the submission of “Always Therapy” procedure codes to include the CMS required therapy modifiers. UHC has provided no new effective date at this time. This requirements was supposed to originally be effective with dates of service on and after July 1, 2019, but in June 2019, UHC further delayed the start of this new requirement until September 1, 2019. To read the latest on this issue straight from UHC, click I hope you enjoyed

The American Medical Association (AMA) has released the calendar year (CY) 2020 CPT codes and there are at least 6 new CPT codes and 6 deleted CPT codes that will impact physical therapists, occupational therapists and/or speech-language pathologists in CY 2020. The new CPT codes will become effective with dates of service on and after January 1, 2020 and be valid for dates of service up to an including December 31, 2020. In addition, the Centers for Medicare and Medicaid Services (CMS) is proposing to change 2 existing CPT codes to an active status meaning that CMS will assign work

UnitedHealthcare (UHC) Community Plan is adding 3 states (in addition to the 4 previously announced) that will require prior authorization prior to initiating physical, occupational and/or speech therapy services. In addition, UHC Community Plan is adding site of service medical necessity reviews for all speech, occupational and physical therapy services provided in a hospital outpatient setting in 2 of the 3 states. The new impacted states are

Effective with dates of service beginning on and after January 1, 2020, the Centers for Medicare and Medicaid Services (CMS) will require 2 new modifiers be appended to CPT codes on the claim form when those services are provided “in whole” or “in part” by a physical therapist assistant (PTA) or an occupational therapy assistant (OTA). To make matters worse, beginning with dates of service on and after January 1, 2022, services that contain one of the two modifiers appended to them on the claim form will be paid at 85% of the normal rate of the Medicare allowed amount

Due to a recent report by the Office of the Inspector General that found payments for Inpatient Rehabilitation Facility (IRF) services did not comply with Medicare billing requirements, CMS developed the IRF Prospective Payment System booklet as well as additional resources in assisting IRFs become more compliant with IRF billing. To access these resources, click HERE.

The Centers for Medicare and Medicaid Services (CMS) has released the Fiscal Year 2020 final rule for the Prospective Payment System (PPS) and Consolidated Billing for Skilled Nursing Facilities (SNF). This final rule finalizes the new payment system, Patient Driven Payment Model (PDPM), that goes into effect with dates of service on and after October 1, 2019. In addition, the final rule revises the definition of group therapy under the SNF PPS and updates requirements for the SNF Quality Reporting Program (QRP) and the SNF Value-Based Purchasing (VBP) Program. To access the final rule, click HERE. In addition, Gawenda Seminars

Due to a recent finding by the Office of the Inspector General (OIG) finding that the Medicare program improperly paid for Skilled Nursing Facility (SNF) services when the Medicare 3-Day inpatient hospital stay requirement was not met, the Centers for Medicare and Medicaid Services (CMS) has developed a Fact Sheet to explain the SNF 3-day rule billing as well as several other resources. To access the Fact Sheet and additional resources, click HERE.