SGR & Exception Process Update

On December 18, 2013, the Senate passed the House bi-partisan budget bill which contains important provisions for providers of outpatient therapy services. The bill addresses the 20.1% reduction scheduled to begin on January 1, 2014, the therapy cap exception process (i.e. use of KX-modifier), the status of hospital outpatient departments and the therapy cap in…

CMS Revises Medicare Policy to Ensure Coverage for Skilled Maintenance Care

The Centers for Medicare and Medicaid Services (CMS) have announced that the Medicare Policy Manuals have been revised pursuant to the Jimmo vs. Sebelius Settlement. The Jimmo case ended a longstanding practice denying Medicare coverage to people who  had “plateaued,” or were “chronic,” or “stable,” or “not likely to improve.” The Manual revisions clarify that…

CMS Releases the 2014 Final Rule

On November 27, 2013, the Centers for Medicare and Medicaid Services (CMS) released the final rule for services reimbursed under the Medicare Physician Fee Schedule (MPFS). The final rule contains information on the 2014 conversion factor used to determine payment, 2014 therapy cap, therapy cap exception process, manual medical review process, application of the therapy…

UHC Updates Speech Generating Policy

UnitedHealthcare (UHC) has updated their speech generating policy due to Section 6407 of the Affordable Care Act (ACA) that established a face-to-face encounter requirement for certain items of durable medical equipment (DME) (including speech generating devices). The law requires that a physician must document that a physician, nurse practitioner, physician assistant or clinical nurse specialist…