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03/25/19

Denials for Canalith Repositioning (CPT Code 95992)

I have been receiving emails from some of my followers regarding their Medicare Administrative Contractor (MAC) not paying for CPT code 95992 – Canalith repositioning procedure(s) (eg, Epley maneuver, Semont maneuver), per day. This CPT code came out in 2009 and the Centers for Medicare and Medicaid Services (CMS) made this a payable CPT code in 2011. This CPT code is a “per day” CPT code meaning  

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03/19/19

Anthem Delays Implementation of New Utilization Management Program

Anthem BC has announced its delayed implementation of AIM for the state of California. The AIM Utilization Management program will not go live on March 25, 2019. The new implementation date will be communicated once it becomes available.

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03/18/19

How to Bill for Services Provided By a PTA or OTA

A question I often receive is how do I bill for services provided to a Medicare or non-Medicare beneficiary that were provided by a physical therapist assistant (PTA) or an occupational therapy assistant (OTA). The answer to the question depends upon your practice setting. In a private practice setting (you submit claims on a 1500-claim form to the insurance carrier), the services of a PTA or OTA are billed

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03/12/19

Home Health Patient-Driven Groupings Model

Effective January 1, 2020, home health services will now be reimbursed under a new system called the Patient-Driven Groupings Model (PDGM). The PDGM changes the unit of payment from 60-day episodes of care to 30-day periods of care and eliminates the therapy thresholds for use in determining home health payment. Per the Centers for Medicare and Medicaid Services (CMS), the PDGM will assign 30-day periods of care into one of 432 case-mix groups based on the following variables: • Timing: The first 30-day period of care is an early period of care. The second or later 30-day period of care

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03/12/19

Nursing Home and Swing Bed Providers

Do you work in a skilled nursing facility (SNF) or a Swing Bed organization. Are you in a management role in a SNF or Swing Bed organization? Do you know how to find the latest news, references and manuals, training, and FAQs applicable to the SNF and Swing Bed settings? If you answered yes to one or both of the first 2 questions and no to the last question, this article will help you immensely. This article will provide links to the latest news impacting the SNF and Swing Bed settings, references and manuals pertaining to MDS 3.0 Provider User’s

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03/07/19

Wisconsin Physician Services to Remain in Michigan and Indiana

The Centers for Medicare and Medicaid Services (CMS) has awarded Jurisdiction 8 (states of Indiana and Michigan) to the incumbent Medicare Administrative Contractor, Wisconsin Physician Services. To read the transmittal from CMS, click HERE.

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03/04/19

CMS Updates Hospital Compare Data

Do you want to know how your hospital compares to other hospitals? Check out the latest Hospital Compare data that was updated on February 28, 2019 by clicking HERE.

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03/04/19

Modifiers 96 and 97: What are They and When To Use Them

Effective for dates of service on and after January 1, 2018, there were 2 new modifiers that providers of outpatient physical, occupational and speech therapy may be required to use with some insurance carriers, such as Affordable Care Act (ACA) compliant plans, to distinguish whether the service provided was rehabilitative in nature or habilitative in nature. The new modifiers replaced the SZ modifier for habilitative services, unless instructed otherwise by an insurance carrier. The 2 new modifiers that became effective January 1, 2018 are Modifier 96 and Modifier 97. What are the definitions of each modifier and when would you

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