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08/20/18

What Documentation is Required in a Progress Report

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:

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08/13/18

Which CPT Codes Require Direct One-on-One Contact

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

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08/06/18

What Has to Be on a Physician Order

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

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07/29/18

Are Patient Sign-In Sheets a HIPAA Violation

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

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07/29/18

Does HIPAA Apply to Me?

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) covers both individuals and organizations. These organizations and individuals are often called HIPAA-covered entities. Covered entities who must comply with Administrative Simplification national standards for sharing business and insurance-related information include: Health plans Health care clearinghouses Health care providers who exchange business and insurance-related tasks electronically Not sure if you are a HIPAA covered entity or not? Click HERE to use the CMS Covered Entity Guidance Tool.

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07/26/18

Comprehensive Error Rate Testing (CERT) Update

The Centers for Medicare and Medicaid Services (CMS) has issued an update with details on no response and insufficient documentation errors in the Comprehensive Error Rate Testing (CERT) program. The instructions tell the CERT review contractors how to handle providers who either do not respond to the additional development request (ADR) and/or send inadequate documentation to support payment for the service(s) billed. To review the instructions, click HERE.

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07/23/18

Medicare Locum Tenens

Are you a physical therapist who owns their own practice and wants to take some well-deserved time off and take a vacation? Do you own a physical therapist private practice and employ other physical therapists who will take vacation time or possibly, an extended amount of time off due to an illness or family emergency? If you answered yes to either question, this is an article that you must read. The Centers for Medicare and Medicaid Services (CMS) has implemented section 16006 of the 21st Century Cures Act that allows outpatient physical therapy services furnished by physical therapists in private

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07/12/18

CMS Releases Proposed Rule for 2019 for Therapy Services

On July 12, 2018, the Centers for Medicare and Medicaid Services (CMS) released the proposed rule: “Medicare Program; Revisions to Payment Policies under the Physician Fee Schedule and Other Revisions to Part B for CY 2019; Medicare Shared Savings Program Requirements; Quality Payment Program; and Medicaid Promoting Interoperability Program”. This proposed rule has several proposed changes for outpatient therapy services beginning with dates of service on and after January 1, 2019. Highlights of the proposed rule include the following: Functional limitation reporting Revised description for GN, GO and GP discipline specific modifiers New modifiers for services provided by a physical

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