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06/04/18

UnitedHealthcare Oxford Policy Updates

UnitedHealthcare Oxford has revised their policy on electrical stimulation for the treatment of pain and muscle rehabilitation with an effective date of June 1, 2018. The revised policy discusses functional electrical stimulation (FES), neuromuscular electrical stimulation (NMES), interferential therapy (IFT) and microcurrent electrical nerve stimulation (MENS), just to name a few. The revised policy states when the various forms of electrical stimulation are and are not considered medically necessary. To access the revised policy, log into your Gold account or become a Gold Member and then click

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06/04/18

UnitedHealthcare Updates Speech Therapy Commercial Policy

UnitedHealthcare (UHC) has updated their coverage determination guidelines for their commercial plans for their members requiring speech language pathology services. The effective date for the revised guideline is April 1, 2018. To access the updated guideline, click

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06/01/18

Medicare Appeals Frequently Asked Questions

Do you have questions about the appeals process for Medicare denied claims? Check out these FAQS from First Coast Service Options.

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05/31/18

CMS Proposes Home Health Demonstration Project

The Centers for Medicare and Medicaid Services (CMS) seeks to develop and implement a Medicare demonstration project, which CMS believes will help assist in developing improved procedures for the identification, investigation, and prosecution of Medicare fraud occurring among Home Health Agencies (HHA) providing services to Medicare beneficiaries. This revised demonstration would help assist in developing improved procedures for the identification, investigation, and prosecution of potential Medicare fraud. The demonstration would help make sure that payments for home health services are appropriate through either pre-claim or postpayment review, thereby working towards the prevention and identification of potential fraud, waste, and abuse;

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05/28/18

Will the Secondary Pay if Medicare Doesn’t?

I often receive questions when a Medicare beneficiary exceeds the therapy cap that go something like this: Currently, I have a patient that has gone over the $2010 or $3000 amount for Medicare. She has not progressed and responded to therapy interventions. She insists that her secondary will pick up the full amount if Medicare denies. I’ve used the GA modifier basically telling Medicare the therapy services are not necessary and had the patient sign an advance beneficiary notice of noncoverage (ABN) form. Will the secondary pay if the Medicare program denies? Does it matter if the secondary insurance is

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05/24/18

TRICARE Update

On December 12, 2017, President Trump signed the National Defense Authorization Act (NDAA) into law. One important piece of legislation included in the NDAA directs the Department of Defense (DOD) to add physical therapist assistants (PTAs) and occupational therapy assistants (OTAs) to the TRICARE program as an eligible provider of therapy services. Even though the NDAA is now law, the DOD must now make the change to add PTAs and OTAs as eligible providers of therapy services. The DOD must also establish, in regulations, requirements for the supervision of PTAs and OTAs. Until this is completed, PTAs and OTAs are

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05/24/18

Targeted Probe and Educate Video

The Centers for Medicare and Medicaid Services (CMS) has published a 5-minute video that explains the Targeted Probe and Educate (TPE) program in more detail. To view the TPE video, click HERE. To read a more detailed article I wrote on the TPE program, click HERE.

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05/21/18

What CPT Code to Bill for Patient Education

Therapists and assistants often spend time with patients, a parent of a patient, or a patient’s caregiver such as a spouse, son, daughter or a hired caregiver teaching them exercises to do at home as part of a home exercise program. In addition, therapists and assistants spend time training a patient’s caregiver (i.e. parent, spouse, son, daughter) how to assist the patient with various activities outside of the clinic setting such as gait on level services, ascending/descending steps with an assistive device, dressing, bathing, bed mobility, transfers, feeding and using a speech generating communication device. Two questions I receive concerning

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