On October 30, 2015, the CY 2016 Medicare Physician Fee Schedule (MPFS) final rule was published in the Federal Register. In order to implement corrections to technical errors discovered after publication of the MPFS rule and process claims correctly, Medicare Administrative Contractors will hold claims containing 2016 services paid under the MPFS for up to 14 calendar days, (i.e., Friday, January 1, 2016 through Thursday, January 14, 2016). The hold should have minimal impact on provider cash flow as, under current law, clean electronic claims are not paid sooner than 14 calendar days (29 days for paper claims) after the date of receipt.
The Centers for Medicare and Medicaid Services (CMS ) has announced the dollar amount in controversy required for an Administrative Law Judge (ALJ) hearing or Federal District Court review for calendar year 2016. The amount that must remain in controversy for ALJ hearing requests filed on or before
The Centers for Medicare and Medicaid Services (CMS) has announced the 2016 Medicare premiums and deductibles. As the Social Security Administration previously announced, there will no Social Security cost of living increase for 2016. As a result, by law, most people with Medicare Part B will be “held harmless” from any increase in premiums in 2016 and will pay the same monthly premium as last year, which is $104.90.
Beneficiaries not subject to the “hold harmless” provision will pay $121.80, as calculated reflecting the provisions of the Bipartisan Budget Act signed into law by President Obama. Medicare Part B beneficiaries not subject to the “hold-harmless” provision are those not collecting Social Security benefits, those who will enroll in Part B for the first time in 2016, dual eligible beneficiaries who have their premiums paid by Medicaid, and beneficiaries who pay an additional income-related premium. These groups account for about 30 percent of the 52 million Americans expected to be enrolled in Medicare Part B in 2016.
The Medicare Part B deductible for 2016 (this does impact outpatient therapy) will be
As we enter a new calendar year, insurance benefits and deductibles will renew on January 1, 2016 for Medicare beneficiaries. A question I often receive is how does the Medicare Part B deductible impact the annual therapy cap dollar threshold for physical therapy and speech-language pathology services combined or the separate annual therapy cap dollar threshold for occupational therapy? In this article, I will provide the answers to the following questions:
- What is the therapy cap dollar amount for 2016?
- What is the Medicare Part B deductible for 2016?
- How does the Part B deductible impact the 2016 therapy cap dollar amount?
Lets answer the first question. The therapy cap dollar amount for 2016 for physical therapy (PT) and speech-language pathology (SLP) services combined is
In November 2014, the Centers for Medicare and Medicaid Services (CMS) released the final rules for the outpatient prospective payment system (OPPS) and the Medicare Physician Fee Schedule (MPFS) for calendar year (CY) 2015. In the OPPS final rule, CMS finalized they will begin to collect data on services furnished in off-campus provider-based departments in CY 2015. Hospitals will be required to report the HCPCS “PO” modifier with every code on facility claims for outpatient hospital services furnished in off-campus provider-based departments. Reporting will be voluntary for CY 2015, mandatory reporting will start January 1, 2016.
The question I am receiving from hospital providers is does this final rule and the mandatory use of the PO modifier beginning January 1, 2016 apply to outpatient therapy services that are furnished in off-campus facilities? The answer is
Currently, providers can use the -59 modifier to indicate that a code represents a service that is separate and distinct from another service with which it would usually be considered to be bundled. The primary issue associated with the -59 modifier is that it is defined for use in a wide variety of circumstances, such as a use to identify different encounters, different anatomic sites, and distinct services. Usage to identify a separate encounter is infrequent and usually correct; usage to define a separate anatomic site is less common and problematic; usage to define a distinct service is common and not infrequently overrides the edit in the exact circumstance for which the Centers for Medicare and Medicaid Services (CMS) created the edit in the first place.
The CMS has established 4 new subsets of modifier 59 to combat the abuse of Modifier 59 and to better understand why providers utilize modifier 59. The new subsets of modifier 59 became effective January 1, 2015 and providers can use them now instead of modifier 59; however, they are not mandated for use as of the posting of this article. In this article,, I will provide 5 examples of when the XU modifier would be appropriate to use. The definition of Modifier XU is Unusual Non-Overlapping Service, The Use Of A Service That Is Distinct Because It Does Not Overlap Usual Components Of The Main Service. The examples are as follows: