I have received several questions from therapists in private practice as well as therapists that practice in a hospital setting regarding providing free transportation to Medicare beneficiaries so they can receive outpatient therapy services at their private practice or hospital. They want to know is this legal or would this free transportation service violate the anti-kickback statute? The Office of the Inspector General (OIG) has released several advisory opinions on this topic. If this is a service you are considering providing or are already providing to your Medicare beneficiaries, I would strongly encourage you to read these opinions as well

The Centers for Medicare and Medicaid Services (CMS) has updated CMS Publication 100-02, Medicare Benefit Policy Manual, Chapter 15 – Covered Medical and Other Health Services as well as CMS Publication 100-04, Medicare Claims Processing Manual, Chapter 5 – Part B Outpatient Rehabilitation and CORF/OPT Services to reflect recent changes in outpatient therapy service billing instructions and payment policies related to the Bipartisan Budget Act of 2018 and the calendar year 2019 Medicare physician fee schedule final rule. To access the changes, log in to your Gold Member account and click

Since functional limitation reporting (FLR) (G-codes) is no longer required in 2019 for traditional Medicare Part B therapy patients, does this mean Progress Reports are also no longer required every 10 visits? The answer is

I recently had a question submitted to me by one of my Gold Members. Here is the situation and question. We had a patient who had an auto insurance that was in litigation that settled; however, we did not even get 50 percent of what we charged. Are we allowed to bill the secondary for the remainder for payment? The secondary insurance is Medicare. Here is information I found that may assist you in the future if you encounter this situation. According to the Centers for Medicare and Medicaid Services,

The Centers for Medicare and Medicaid Services (CMS) has released an updated transmittal providing instructions when a skilled nursing facility (SNF) should and should not issue an advance beneficiary notice of non-coverage (ABN) to a Medicare beneficiary. To read the SNF ABN instructions of when to and when not to issue a SNF ABN, ABN specific delivery issues, special rules for SNF ABN’s, establishing when beneficiary Is on notice of non-coverage, and sources of beneficiary notification, click

The National Correct Coding Initiative (NCCI) edits Version 25.0 has been released and is in effect for dates of service January 1, 2019 – March 31, 2019. There are many changes in this version due to the 2019 new and deleted CPT codes. There are several new CPT codes related to Adaptive Behavior as well as Developmental Testing. To access the NCCI Edit Version 25.0 “cheat sheet” applicable to physical therapy, occupational therapy and speech-language pathology services, click HERE. Thank you for being a Gold Member!

First Coast Service Options, Inc, Medicare Administrative Contractor for Florida, Puerto Rico and the Virgin Islands, has revised their local coverage determination (LCD) for Therapy and Rehabilitation Services. To access the revised LCD, log into your account and click

Palmetto GBA, Medicare Administrative Contractor for the states of Alabama, Georgia, North Carolina, South Carolina, Tennessee, Virginia and West Virginia, have revised their physical therapy, occupational therapy and speech therapy local coverage determinations (LCD’s). The effective date for the revisions for all 3 LCD’s is January 1, 2019. To access the revised LCD’s, log into your Gold Member account and click on the following titles below