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07/17/19

CMS Proposes to Cover Acupuncture for CLBP

On July 15, 2019, the Centers for Medicare & Medicaid Services (CMS) released a proposal to cover acupuncture for Medicare patients with chronic low back pain (CLBP) who are enrolled participants either in clinical trials sponsored by the National Institutes of Health (NIH) or in CMS-approved studies. To read the proposed decision memo, click HERE. To submit comments on the proposed decision memo, click HERE.

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07/17/19

Anthem Blue Cross Further Delays Implementation of AIM Specialty Health

Anthem Blue Cross has announced they will further delay the implementation of AIM Specialty Health and the prior authorization process for outpatient therapy services for the 13 states that were originally scheduled to begin with dates of service on and after July 1, 2019. On July 2, Anthem Blue Cross announced the implementation that began July 1, 2019 was being halted and would resume with dates of service on and after August 1, 2019. On July 16, 2019, Anthem Blue Cross announced they are

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07/17/19

CMS Issues CY 2020 Home Health Proposed Rule

The Centers for Medicare and Medicaid Services (CMS) has issued the Home Health proposed rule for calendar year (CY) 2020. In the proposed rule, there are several proposals that could have an impact on physical, occupational and speech therapy services with one of the proposals having a potential positive impact on outpatient therapy services and another proposal recommending changes to who can provide maintenance therapy to Medicare beneficiaries who are under an active Home Health Agency (HHA) plan of care. Proposals that impact therapy services include, but are not limited to the following:

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07/15/19

Identifying the Certifying Physician(s) on a Claim Form

I am often asked by providers of outpatient therapy services how to identify who the certifying physician/non-physician practitioner (NPP) or physicians/NPPs are on the claim form. The answer depends on whether you are a private practice submitting claims on the paper 1500 claim form or the electronic equivalent (i.e. 837P) or you are an institutional provider (i.e. skilled nursing facility, rehabilitation agency, CORF, or hospital outpatient department) submitting claims on the UB-04 electronic claim form (837I). In this article, I will provide the answers to the above including how to identify multiple physicians/NPPs on the claim form when one physician/NPP

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07/03/19

Anthem Delays Preauthorization Implementation for Outpatient Therapy

Breaking News July 2, 2019: Anthem BC announces they will delay implementation of AIM until August 1, 2019. Here is the statement issued by Anthem:

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06/25/19

Anthem BCBS to Require Preauthorization for Outpatient Therapy

Effective July 1, 2019, Anthem Blue Cross patients in several states will require preauthorization to receive outpatient physical, occupational and speech therapy services. This will be true not only for new patients beginning therapy on or after July 1, 2019, but also for current Anthem patients who are being seen now and will continue to be seen for therapy on or after July 1, 2019. The states where prior authorization will be required effective for dates of service on and after July 1, 2019 are:

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06/24/19

Application of Modifier 59 Changing on July 1st

For dates of service on and after July 1, 2019, the Centers for Medicare and Medicaid Services (CMS), as well as UnitedHealthcare (UHC), is changing which CPT code Modifier 59 must be appended to on the claim form in order for both the Column 1 and Column 2 CPT codes to be paid when provided on the same date of service. If you missed my webinar last week on NCCI edits and Modifier 59, click HERE to see the complete webinar description, objectives and to order the recorded version with handouts and Gawenda Seminars & Consulting NCCI edit reference sheet.

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06/17/19

When Does an Order for Therapy Expire

One of the most common questions I am asked via email and in-person during a seminar is “When does an order for therapy expire” or “How old can an order be before a patient starts therapy”? To answer this question, we must look in 3 places. The first is your  

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