Manual Medical Review of Therapy Services

The Centers for Medicare & Medicaid Services (CMS) released transmittal 1117 on August 31, 2012 and was replaced by transmittal 1124 on September 24, 2012 that details what must be submitted when requesting an advance exception to the $3700 therapy cap threshold as well as guidelines the Medicare contractors must adhere to when an exception…

Therapy Cap Update From CMS

On August 31, 2012, the Centers for Medicare & Medicaid (CMS) released transmittal 2537 that provides new and additional information regarding the 2012 therapy cap and the manual medical review process scheduled for implementation on October 1, 2012. Transmittal 2537 also provides information on where to place the certifying physician/NPP NPI number on the claim…

ICD-10 Delayed

On August 24, 2012,the Department of Health and Human Services issued a final rule delaying the implementation of ICD-10 from October 1, 2013 until October 1, 2014. The rule also specifies the circumstances under which an organization-covered health care provider, such as a hospital or nursing home, must require certain noncovered individual health care providers…

First Coast to Audit Physician Therapy Billing

In an effort to protect the Medicare Trust Fund and ensure proper payments, the Centers for Medicare & Medicaid Services (CMS) implemented the Comprehensive Error Rate Testing (CERT) program. CERT measures the accuracy of Medicare fee-for-service (FFS) payments. CERT contractors generate a number of measurements and statistics that reflect how effectively providers submit their claims…