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

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

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

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

I am often asked what the Centers for Medicare and Medicaid Services (CMS) and other private insurance carriers require in terms of documentation in a progress report. In this article, I will provide the progress note documentation requirements for Medicare Part B, Cigna and several state BCBS insurance carriers. Lets start with the Medicare program and what CMS requires in a progress report for outpatient therapy services paid under Part B benefits. The required elements are as follows:

In July, I wrote and published an article “Can I Double Book or Overlap Medicare Patients“. In that article, I explained the definition of “requires direct one-on-one patient contact” and how to do the proper billing when treating 2 or more patients during the same time period, whether Medicare or non-Medicare. In this article, I will provide which CPT codes require the therapist or assistant have direct one-on-one patient contact in order to bill that CPT code to the patient for that visit. According to the American Medical Association, the following CPT codes require direct one-on-one patient contact for physical

I am often asked what items must be on a physician order for a patient referred to outpatient physical, occupational and/or speech therapy services. Can a physician or other qualified practitioner just write “Evaluate and Treat”? Must the physician or practitioner list a frequency and duration on the order? As you can imagine, the answer is not simple. To determine what items must be on a physician/practitioner order for a patient referred to outpatient physical, occupational and/or speech therapy services, you must look at your state practice act, the contract you signed with the insurance carrier as well as the

A question I have been receiving lately involves patient sign-in sheets and are these sign-in sheets a Health Insurance Portability and Accountability Act (HIPAA) violation? To answer this question, I will quote the Centers for Medicare and Medicaid Services (CMS). CMS stated in 2002 that covered entities, such as physician’s offices (this would also include therapists in private practices and nonprivate practices), may