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06/17/19

Novitas Updates Modified Barium Swallow Study LCD

Novitas Solutions, Inc, Medicare Administrative Contractor in the states of Arkansas, Colorado, Delaware, Louisiana, Maryland, Mississippi, New Jersey, Oklahoma and Pennsylvania as well as the District of Columbia, has released a revised local coverage determination (LCD) on Modifier Barium Swallow Studies. The LCD provides covered indications where instrumental assessment of swallowing may be helpful as well as the settings where the procedure will be reimbursed if medically necessary. To access the LCD, log into your account and click

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06/10/19

Can New PT and PTA Graduates Treat Medicare Patients

A question I often receive is can a new graduate physical therapist or graduate physical therapist assistant treat Medicare patients while they are waiting to take their national examination and have their services supervised by a licensed physical therapist (PT) or physical therapist assistant (PTA) and billed to the Medicare program? Does the Centers for Medicare and Medicaid Services (CMS) answer this question and if yes, where is the answer? In this article, when I mention Medicare, I am referring to traditional Medicare and not Medicare Advantage plans. Yes, CMS does answer this question and the answer can be found

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06/04/19

UHC to Require Therapy Modifiers for Reimbursement

This article was originally published on May 20, 2019. Information has been updated as of June 3, 2019. Please read below for further details. Changes are coming to UnitedHealthcare and billing for outpatient therapy services. Failure to be aware of this change will cause your claims not to be paid beginning this summer. UHC has announced they will begin requiring the application of the therapy specific

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06/03/19

Distinguishing Between the GA, GX, GY and GZ Modifiers

There are many modifiers providers of therapy services are use to adding to CPT codes on the claim forms. Common modifiers include the KX modifier, 59-modifier and therapy specific modifiers of GN, GO and GP. But do you know the following modifiers and when to use them: GA, GX, GY and GZ? In this article, I will discuss when to use these modifiers on a CPT code on the claim form for therapy services. In addition, if you have additional questions on when to issue an advance beneficiary notice of non-coverage (ABN) form to a Medicare beneficiary, check out my

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05/27/19

How to Document Time in the Medical Record

Lately, I have been receiving questions regarding what must a therapist or an assistant document in regards to time for patients receiving outpatient therapy services under Medicare Part B. Does the Medicare program require time in and time out? Does the Medicare program require we document the minutes spent on each individual CPT code. In this article, I will answer what the Medicare program does and does not require in terms of documentation of time for each therapy visit as well as Medicare Advantage plans, Medicaid, private/commercial insurance carriers and workers compensation carriers. For outpatient therapy services provided under Medicare

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05/27/19

Outpatient Therapy Common CERT Errors

The Centers for Medicare and Medicaid Services (CMS) has released a new booklet where they describe common outpatient rehabilitation therapy services Comprehensive Error Rate Testing (CERT) Program errors, how the CMS calculates improper payment rates, the necessary documentation to support billed Medicare claims, and managing potential overpayments. Some of the more common CERT errors include:  

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05/20/19

UnitedHealthcare Community Plan Therapy Changes

UnitedHealthcare (UHC) Community Plan will begin Site of Care Medical Necessity Reviews and are also revising their prior authorization requirements for occupational, physical and speech therapy services. Beginning with dates of service on and after  

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05/17/19

Recovery Audit Program and Therapy Services

The Medicare Fee-For-Service Recovery Audit Program was initiated in 2009 to reduce improper Medicare payments to suppliers and providers enrolled in the Medicare program. Since its inception, the program has recouped more than $10 billion for the Medicare program. It should be to no ones surprise that therapy services have contributed to the more than $10 billion recouped. Current approved topics pertaining to therapy include: 0138-SNF-Consolidated Billing for Therapies 0124-Part B Therapies in a Hospital Setting 0073-Inpatient Rehabilitation Facility Stays: Meeting Requirements to be Considered Reasonable and Necessary To access the complete list of approved topics, click HERE. Proposed topics

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