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.

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.

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

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

Wisconsin Physician Services (WPS) will be providing a free teleconference on skilled nursing facility (SNF) consolidated billing on July 25, 2018 from 11:00AM – 12:30PM ET. For additional information and to register, click HERE.

People always ask me if I can double book and/or overlap Medicare patients receiving outpatient therapy services. I’m going to answer this question once and for all and the answer will not only apply to outpatient therapy services paid under Medicare Part B benefits, but will also apply to commercial and workers compensation carriers. What we need to remember is no insurance carrier cares or dictates how you schedule their patient’s for outpatient therapy services and this also includes the Medicare program. What insurance carriers, including the Medicare program, do care about is that their patient’s receive quality and medically

On July 2, 2018, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule [CMS-1689-P] outlining proposed Calendar Year (CY) 2019 Medicare payment updates and proposed quality reporting changes for home health agencies (HHAs), and proposed case-mix methodology refinements and a change in the home health unit of payment from 60 days to 30 days for CY 2020. To view a Fact Sheet on the proposed rule, click HERE. To access the proposed rule, click HERE.

I receive many questions regarding Medicare Part B certifications and recertifications as they pertain to outpatient physical, occupational and speech therapy services. In this article, I will answer the following questions: 1. How long is a certification and recertification valid for under Medicare Part B outpatient therapy services? 2. How soon must a plan of care be signed by a physician or NPP to be considered timely under Medicare Part B rules and regulations? 3. What is delayed certification and recertification?  4. What are some possible justifications to support delayed certification or recertification? 5. If I only do an evaluation