Last week, I wrote an article explaining how much time of a time-based CPT code must be provided in order to bill that CPT code to an insurance carrier as well as explaining the difference between Medicare’s “8-minute rule” and the American Medical Association (AMA) definition of substantial when billing a time-based CPT code. This article then led people to ask me if I can double book and/or overlap Medicare patients receiving outpatient therapy services. I’m going to answer this question once and for all and the answer will not only apply to outpatient therapy services paid under Medicare Part

Noridian Healthcare Solutions will be hosting a free 30-minute webinar on May 21, 2019 at 1:00pm CT to discuss outpatient therapy certifications and recertifications. The webinar will include: Overview What is a Certification When to recertify Signatures Common Errors Resources For additional information and to register, click HERE.

For those of us that treat Medicare beneficiaries for outpatient physical, occupational and/or speech-language pathology services, we all understand that the Medicare program utilizes what as come to be known as the “8-minute rule” when determining how many time-based units can be billed during an outpatient therapy visit. But what about non-Medicare insurance carriers that do not utilize the “8-minute rule”? How do we determine how much time of a time-based CPT code must be provided in order to bill that CPT code to an insurance carrier that does not follow the Medicare “8-minute rule”? In this article, I will

Novitas Solutions, Inc., Medicare Administrative Contractor (MAC) for the states of Arkansas, Colorado, Delaware, Louisiana, Maryland, Mississippi, New Mexico, New Jersey, Oklahoma, Pennsylvania, and Texas as well as the District of Columbia, has issued a revised physical therapy and occupational therapy local coverage determination (LCD) with an effective date of April 18, 2019. The LCD lists the most common CPT codes utilized by physical and occupational therapists and provides indications when the CPT code would be applicable to bill and supportive documentation requirements. To access the LCD, log into your Gold Member account and click

Palmetto GBA, Medicare Administrative Contractor (MAC) for Jurisdiction J which includes the states of Alabama, Georgia and Tennessee, currently has two active medical reviews for outpatient therapy services for non-private practice settings. The two reviews are focused on CPT code 97110 (therapeutic exercise) and CPT code 97140 (manual therapy). When the results of the review are posted, I will write an article on the findings.

On April 5, 2019, the Centers for Medicare and Medicaid Services (CMS) issued the final rule for Medicare Advantage (MA) program (Part C) regulations and Prescription Drug Benefit program (Part D) regulations for calendar year 2020. In this final rule, CMS is implementing several sections of the Bipartisan Budget Act of 2018. One of the sections CMS is implementing is Section 50323 that will allow MA plans to offer “additional telehealth benefits” as part of the government-funded “basic benefits”. Will these “additional telehealth benefits” include physical therapists (PTs), occupational therapists (OTs) and speech-language pathologists (SLPs)? Continue reading to find out.

The Centers for Medicare and Medicaid Services (CMS) has released the Skilled Nursing Facility (SNF) fiscal year (FY) 2020 proposed rule. CMS has published a fact sheet that highlights 3 major provisions of the proposed rule that are: The proposed changes to SNF payment policy under the SNF Prospective Payment System (PPS) The SNF Value-Based Purchasing Program (VBP) The SNF Quality Reporting Program (QRP) In FY 2020, CMS expects payments to SNF’s to increase by 2.5% compared to FY 2019. CMS is proposing to change the definition of group therapy in the SNF Part A setting to align with the

The Centers for Medicare and Medicaid Services (CMS) has released the fiscal year (FY) 2020 Inpatient Rehabilitation Facility (IRF) proposed rule. Highlights of the proposed rule include: CMS projects that IRF payments will increase by 2.3 percent for FY 2020 Revising the case-mix groups based on two years of data (FY 2017 and FY 2018) from the quality indicator data items and update the relative weights and average length of stay values associated with the revised case-mix groups beginning on October 1, 2019. Proposing 2 new interoperability measures for the IRF rule to implement the final requirements of the IMPACT