I receive many questions concerning when is it appropriate to bill for a reevaluation to an insurance carrier. A few of the questions I receive are: Can I bill for a reevaluation for when I’m required to complete a Progress Report on a Medicare patient or for that matter, any patient? Can I bill for a reevaluation because my state practice act requires I perform a reevaluation at certain timeframes from the start of care? Can I bill a reevaluation when I’m already seeing a patient for one condition/diagnosis and while still treating that condition, they bring in a referral

Wisconsin Physician Services (WPS) has several webinars upcoming for the skilled nursing facility (SNF setting. Upcoming webinars include, but are not limited to: SNF Coverage Requirements & Admission Procedures SNF Billing Basics, Adjustments, & Cancellations SNF Benefits Exhaust & No-Pay Billing SNF Billing Beyond the Basics SNF Consolidated Billing (Part 1) SNF Consolidated Billing (Part 2) For detailed information on each webinar and to register, click HERE.

The Centers for Medicare and Medicaid Services (CMS) has announced a significant change to the use of modifier 59, XE, XP, XS and XU effective July 1, 2019. Currently, the multi-carrier system (MCS) claims system processing logic for modifier 59, XE, XP, XS and XU be appended to the column two CPT code of a procedure to procedure (PTP) edit in order to bypass the edit and allow both CPT codes to be paid by the Medicare Administrative Contractor (MAC). Beginning with dates of service on and after July 1, 2019, the CMS will Click HERE to view the latest

CMS would like to announce that on February 1, 2019, the National Correct Coding Initiative (NCCI) Medicare and Medicaid Program Contract was awarded to a new contractor, Capitol Bridge LLC (2300 9TH STREET, SOUTH, PH3 ARLINGTON, VA 22204 Congressional District: VA-08). The incumbent contractor, CCS WP LLC/Correct Coding Solutions LLC and its principles will be retiring on March 16, 2019, immediately after the transition period with Capitol Bridge LLC. The transition period started on February 3, 2019, and will end on March 15, 2019. Please continue to send all correspondence to CCS WP LLC/Correct Coding Solutions LLC until March 14,

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  

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.

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

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