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10/15/18

Medicare 2019 Deductibles and Premiums Announced

The Centers for Medicare and Medicaid Services (CMS) has announced the 2019 Medicare Part A and Part B premiums and deductibles. In this article, I will provide you with what the premiums and deductibles are for 2019 and how the Medicare beneficiaries Part B deductible can impact the annual therapy threshold dollar amount dependent upon was the deductible met before or after they received outpatient physical, occupational and/or speech therapy services. Lets begin with the 2019 Part B deductible and monthly premiums. In 2019, the Part B deductible will be

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10/09/18

2019 Medicare Advantage Update

The Centers for Medicare and Medicaid Services (CMS) has released data that provides important premium and cost sharing information for Medicare health and drug plans offered in 2019. According to the CMS Fact Sheet: Enrollment in Medicare Advantage is projected to be at an all-time high in 2019 with 22.6 million Medicare beneficiaries. This represents a projected 2.4 million (11.5 percent) increase from 20.2 million in 2018. Based on projected enrollment, 36.7% of Medicare beneficiaries will be enrolled in Medicare Advantage in 2019. Medicare Advantage premiums, on average, have steadily declined since 2015 from the actual average premium of $32.91.

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10/08/18

Participating vs Non-Participating Provider with Medicare: What’s the Difference

Last week, I published an article titled “How to Bill Medicare for a Therapist Not Yet Credentialed“. This article then led to readers asking must physical therapists (PTs), occupational therapists (OTs), and speech-language pathologists (SLPs) in private practice enroll in the Medicare program if they want to treat Medicare beneficiaries? The answer is yes. PTs, OTs and SLPs in private practice must enroll in the Medicare program if they want to treat Medicare beneficiaries for services that would be covered by the Medicare program. In addition, once they enroll in the Medicare program, PTs, OTs and SLPs in private practices

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10/05/18

UHC Prior Authorization Update for Therapy

Effective for dates of service on or after Oct. 1, 2018, the following procedure codes will require prior authorization for UnitedHealthcare Community Plan of Mississippi (Medicaid, CHIP Plans): Speech Therapy: CPT Code 92507

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10/02/18

Dry Needling CPT Code in the Future?

The American Physical Therapy Association partnered with the American Chiropractic Association and presented an application for a dry needling CPT code at the American Medical Association CPT Meeting in Boston, September 27-29. APTA will provide an update on the results of the meeting after the meeting information is made public. Watch for an updated article on my website once the information is made public.

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10/01/18

How to Bill Medicare for a Therapist Not Yet Credentialed

A question I receive often from therapists in private practice is “I just hired a new physical therapist (PT), occupational therapist (OT) and/or speech-language pathologist (SLP) and they are not yet approved as a Medicare provider; can they see Medicare patient’s while waiting to become approved and if yes, how do I bill for their visits?” In this article, I will explain the 2 options private practices have when this situation occurs. Keep in mind that when I say Medicare, this is traditional Medicare Part B and does not include Medicare Advantage plans. Option #1

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09/27/18

CJR Slashed Payments in First 8 Months of Implementation

The Comparative Joint Replacement (CJR) program was implemented on April 1, 2016 and in the first year (which was only 8 months), the program saw average total payments decrease by 3.9% or $1,127 compared to hospitals not participating in the model according to a report prepared by The Lewin Group for the Centers for Medicare and Medicaid Services (CMS). The study analyzed results from 731 CJR participant hospitals and 841 hospitals not in the experiment, which lasted from April 1, 2016 to Dec. 31, 2016. However, in 2017, CMS scaled back the CJR program is now only mandatory in 34

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09/24/18

Can I Treat Family and Bill Medicare

Providers always want to know if they can treat family members who have Medicare as their insurance and submit the claims for those services to the Medicare program and receive reimbursement. Well, to answer that question, we must look at what the Centers for Medicare and Medicaid Services (CMS) has to say on this matter. The answer can be found in  

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