Therapy Modifier Consistency Edits

The Centers for Medicare and Medicaid Services (CMS) has released an article in which CMS creates edits in original Medicare claims processing systems to ensure that certain ‘always therapy’ evaluation and reevaluation codes are reported with the correct modifier. It also makes several clarifications of details in the “Medicare Claims Processing Manual,” Chapter 5 –…

Documentation Requirements for Physicians Who Order DMEPOS

The Medical Directors for all 4 DME Medicare Administrative Contractors (MACs) have developed “Dear Physician” letters to help define medical necessity requirements of specific items such as diabetic supplies, oxygen equipment, power wheelchairs and power operated devices, hospital beds, therapeutic shoes for diabetics, nebulizers, etc., for ordering physicians. If the treatment plan includes durable medical…

Documentation Requirements for Home Health Prospective Payment System Face-to-Face Encounter

The Centers for Medicare and Medicaid Services has released an article intended for physicians who refer patients to home health, order home health services, and/or certify patients’ eligibility for the Medicare home health benefit, home health agencies, and non-physician practitioners (NPPs). Effective January 1, 2011, the Affordable Care Act mandates that prior to certifying a…