SNF ABN Requirements Clarified

The Centers for Medicare and Medicaid Services have issued clarification instructions on the use of the skilled nursing facility (SNF) Advance Beneficiary Notice (ABN) of Non-Coverage form pursuant to the Jimmo vs Sebelius settlement. The instructions cover common denial reasons why the extended care items or services are noncovered under Medicare. The SNF may use…

Therapy Cap Exception Process

If Congress does not pass additional legislation either eliminating the therapy cap or extending the exception process prior to April 1, 2014, Medicare beneficiaries will not have coverage for outpatient therapy services once they exceed $1920 PT and SLP combined or a separate $1920 for occupational therapy. If no legislation is passed and no exception…

Functional Limitation Reporting Processing Issues

First Coast Service Options, National Government Services (NGS) and Novitas Solutions have announced that claims reporting Outpatient Therapy Functional G-codes and modifier information may be incorrectly receiving errors from the Common Working File (CWF) causing incorrect denials. The issues have been referred to CWF system maintainer for research and resolution. CWF has acknowledged an issue…

Humana and MPPR

The Humana health insurance corporation has nearly completed processing refunds owed to practitioners who were incorrectly billed during an “overpayment recovery” process last year. The overpayments were part of Humana’s attempt to implement the multiple procedure payment reduction (MPPR) policy retroactively, and the problems have contributed to a Humana decision to hold off on full…