The Office of the Inspector General (OIG) has issued a report recommending the Centers for Medicare and Medicaid Services (CMS) accelerate their efforts to implement a new method for paying for therapy services. A new payment method may eliminate the need for the new assessments by basing payments on beneficiary characteristics rather than on the amount of therapy provided. In the meantime, CMS should mitigate the problems with the new therapy assessments by (1) reducing the financial incentive for SNFs to use assessments differently when decreasing and increasing therapy and (2) strengthening the oversight of SNF billing for changes in therapy. CMS concurred with both of the OIG recommendations. To read the full report, click HERE.
I am often asked by therapists, office managers, biller’s, billing companies, etc., if the application of the KX modifier is allowed for Medicare beneficiaries who have exceeded $3700 physical and speech therapy combined in a calendar year or a separate $3700 for occupational therapy in a calendar year. Providers of therapy services are under the impression that Medicare beneficiaries have 2 therapy caps, one at $1940 in calendar year 2015 and a second therapy cap at $3700. Providers are also under the impression that once a Medicare beneficiary exceeds $3700, the KX modifier is no longer allowed to be applied to CPT codes on the claim form and that they must have the Medicare beneficiary or their representative sign an advance beneficiary notice of noncoverage even though the treating therapist has determined services are still medically necessary and require the unique skills of a therapist to provide.
Lets make one thing clear. There is only one annual therapy cap and in 2015, it is
The past 2 weeks, I wrote on 2 primary reasons why a provider may have to issue an advance beneficiary notice of noncoverage (ABN) to a Medicare beneficiary receiving outpatient therapy services. In this week’s article, I am going to teach providers how to complete the ABN form and provide examples of completed ABN forms.
The Centers for Medicare and Medicaid Services (CMS) has an ABN form, CMS-R-131, on their website that suppliers and providers can use to notify Medicare beneficiaries of expected noncoverage of a service or services provided. If suppliers and providers wish to, they can develop their own equivalent of the ABN form; however, it must be produced on a single page in either letter or legal size and contain all the required fields and information as is on the CMS ABN form.
The CMS ABN form is comprised of 10 blanks, labeled A through J, that must be completed in order for the ABN to be considered valid. I will now explain what information must go in each of the 10 fields and at the end of this article, provide an example of a completed ABN form for outpatient therapy services. To view the entire article, log in or become a Gold Member now.
In last week’s article, I provided one of the main reasons when a provider would need to issue an advance beneficiary notice of noncoverage (ABN) to a Medicare beneficiary receiving outpatient therapy services. To see last week’s article, click HERE. In today’s article, I am going to explain why a provider would need to issue an ABN to a Medicare beneficiary that requires iontophoresis as part of their therapy plan of care.
First, lets answer the question “Does the Medicare program cover iontophoresis”? The answer is yes. Nationally, the Medicare program does cover and pay for iontophoresis. So you might be asking yourself then why if the Medicare program covers and pays for iontophoresis would I need to have a Medicare beneficiary that requires iontophoresis as part of their therapy plan of care sign an ABN? Great question! The answer is because some of the Medicare Administrative Contractors (MACs) that process your therapy claims have decided that iontophoresis is
The Centers for Medicare and Medicaid Services (CMS) conducted their second ICD-10 end-to-end testing the week of April 27 – May 1, 2015 and the results released today show CMS is ready for the implementation of ICD-10 on October 1, 2015. Approximately 875 providers, clearinghouses and billing agencies accounting for nearly 1600 registered NPI’s participated in the testing week.
The acceptance rate for April was higher than January, with an increase in test claims submitted and a decrease in the percentage of errors related to both ICD-9 and ICD-10 diagnosis codes.
• 23,138 test claims received
• 20,306 test claims accepted
• 88% acceptance rate
• 2% of test claims were rejected due to invalid submission of ICD-10 diagnosis or procedure code
• <1% of test claims were rejected due to invalid submission of ICD-9 diagnosis or procedure code
Additional rejections were from non-ICD-10 related errors, including incorrect NPI, Health Insurance Claim Number, or Submitter ID; dates of service outside the range valid for testing; invalid HCPCS codes; and invalid place of service. These types of errors also occurred in the January end-to-end testing week. To read the full press release from CMS, click HERE.
Not ready for ICD-10 or you want additional training? We can help! Later this month, Rick will be hosting two webinars. The first is on June 24th and will focus on ICD-10 for PT and OT. The second is June 25th and will focus on ICD-10 for SLP. Click HERE to view all our upcoming webinars, full course description and objectives and to register.
In last week’s newsletter, I provided the answers to the following 3 questions regarding routine ABN’s:
- Can we have all of our Medicare patient’s sign an advance beneficiary notice (ABN) on their initial appointment to protect us in case our Medicare Administrative Contractor (MAC) denies any of our services as not medically necessary?
- Once a Medicare beneficiary reaches the annual therapy cap dollar threshold ($1940 for physical therapy and speech therapy combined and a separate $1940 for occupational therapy in calendar year 2015), can I have the Medicare beneficiary sign an ABN even though I feel the therapy services are medically necessary to protect us in the event my Medicare contractor denies the services as not medically necessary?
- Once a patient exceeds $3700 in covered PT and SLP services combined or a separate $3700 in covered OT services in a calendar year, can I have the Medicare beneficiary sign an ABN even though I feel the therapy services are medically necessary to protect us in the event my Medicare contractor denies the services as not medically necessary?
To see the answer’s to the above 3 questions, click HERE.
In this week’s newsletter, I am going to provide one of the main reasons when a provider would need to issue an ABN to a Medicare beneficiary receiving outpatient therapy services. In next weeks newsletter, I will provide additional reasons when an ABN would need to be issued to a Medicare beneficiary receiving outpatient therapy services.
One of the main reasons an ABN would need to be issued to a Medicare beneficiary receiving outpatient therapy services is if the Medicare beneficiary is also