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09/17/18

Want an Increase in Medicare Payment? Participate in MIPS

Automatic annual increases in Medicare payment for outpatient therapy services is coming to an end after 2019 unless you participate successfully in the Merit-Based Incentive Payment Program (MIPS). Due to the passage of the Medicare Access and Chip Reauthorization Act of 2015, providers of outpatient therapy services received an annual update of 0.5% from July 2015 through 2019. For calendar years 2020-2025, there will be no update to the conversion factor that CMS uses to determine the payment amount for each CPT code paid under the Medicare Physician Fee Schedule. For 2026 and beyond, providers who participate in alternative payment

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09/10/18

What are the GA, GX, GY and GZ Modifiers

There are many modifiers providers of therapy services are use to adding to CPT codes on the claim forms. Common modifiers include the KX modifier, 59-modifier and therapy specific modifiers of GN, GO and GP. But do you know the following modifiers and when to use them: GA, GX, GY and GZ? In this article, I will discuss when to use these modifiers on a CPT code on the claim form for therapy services. The GA modifier is defined as waiver of liability statement on file. The GA modifier must be used when therapy providers want to indicate

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09/07/18

Noridian Healthcare Solution Publishes Prefabricated Splint Article

Noridian Healthcare Solution, Medicare Administrative Contractor for the states of Alaska, Arizona, Idaho, Montana, Oregon, North Dakota, South Dakota, Utah, Washington, and Wyoming, has published a revised article providing clarification regarding the billing of CPT codes 29105, 29125, 29126, 29130, 29131, 97760, 97799 for the application of a splint when also billing the L code the same day. To access the article, log into your Gold account and click

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09/07/18

Noridian Healthcare Solutions Publishes Maintenance Program Article

Noridian Healthcare Solution, Medicare Administrative Contractor for the states of Alaska, Arizona, Idaho, Montana, Oregon, North Dakota, South Dakota, Utah, Washington, and Wyoming, has published a revised article providing clarification regarding outpatient therapy services and maintenance programs. To access the article, log into your Gold account and click

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09/05/18

Aetna to Require Prior Authorization in 4 States

Effective September 1, 2018, Aetna will begin requiring prior authorization for physical therapy and occupational therapy in 4 states. The 4 states are

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09/03/18

What Documentation is Required in a Daily Note

On August 20, 2018, I published “What Documentation is Required in a Progress Report“. Click HERE to access this article. That article then led readers to ask me what the Centers for Medicare and Medicaid Services (CMS) and other commercial insurance carriers require in daily note documentation. In this article, I will provide the daily note documentation requirements for Medicare Part B, Cigna, several state BCBS insurance carriers, and a few state physical therapy practice acts. Lets start with the Medicare program and what CMS requires in a daily note for outpatient therapy services paid under Part B benefits. The

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08/29/18

Who Will MIPS Apply To?

The Physician Quality Reporting System (PQRS) that physical, occupational and speech therapists have had to participate in the past several years to avoid a payment reduction ended on December 31, 2016. PQRS was replaced with a new program called Merit-Based Incentive Payment System (MIPS) that combines 3 previous programs and adds one additional category. Providers participating in MIPS will have to show they provided high quality, efficient care supported by technology by sending in information in the following categories: Quality (Replaces PQRS) Improvement Activities (New Category) Promoting Interoperability (Replaces the Meaningful Use Program) Cost (Replaces the Value-Based Modifier) In 2017

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08/27/18

What is MIPS and Should I Care?

The Physician Quality Reporting System (PQRS) that physical, occupational and speech therapists have had to participate in the past several years to avoid a payment reduction ended on December 31, 2016. PQRS was replaced with a new program called Merit-Based Incentive Payment System (MIPS) that combines 3 previous programs and adds one additional category. Providers participating in MIPS will have to show they provided high quality, efficient care supported by technology by sending in information in the following categories: Quality (Replaces PQRS) Improvement Activities (New Category) Promoting Interoperability (Replaces the Meaningful Use Program) Cost (Replaces the Value-Based Modifier) In 2017

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