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02/09/18

Congress Repeals Medicare Therapy Cap

In the early morning hours of February 9, 2018, the United States Senate and House of Representatives both passed legislation that repeals the outpatient therapy cap; however, changes payment rates for services provided by a physical therapist assistant and/or occupational therapy assistant to Medicare beneficiaries receiving outpatient therapy services. In addition, the legislation also makes changes to the Home Health Agencies and Part A home health services. President Trump signed the bill into law early Friday morning. The therapy cap repeal is effective with dates of services on and after

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02/08/18

Medicare Program to Pay for TKAs On An Outpatient Basis

The Centers for Medicare and Medicaid Services, on November 1, 2017, finalized their proposed rule to remove total knee arthroplasty (TKA) from the inpatient procedure only (IPO) list and allow Medicare beneficiaries to have their knee replaced on an outpatient basis beginning with dates of service on and after January 1, 2018. This procedure will be paid under the outpatient prospective payment system (OPPS). Removal of the TKA from the IPO list does not preclude a Medicare beneficiary from having a TKA as an inpatient. The decision whether to have a TKA as an inpatient or an outpatient will be

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02/05/18

2018 Therapy Cap as of February 5, 2018

The House of Representatives and the Senate have failed to act to pass legislation to either repeal the outpatient therapy cap or to extend the therapy cap exception process for Medicare beneficiaries receiving outpatient physical and/or occupational therapy as well as speech-language pathology services in calendar year 2018. So what does this mean for providers of therapy services and their Medicare beneficiaries who started receiving outpatient therapy services the first week of 2018 and continue those services this week (week of February 5, 2018) and may exceed the $2010.00 hard therapy cap? Here is the latest! If a Medicare beneficiary

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02/05/18

SLPs Billing CPT Codes 97110, 97112 & 97530

A question I receive is can speech-language pathologists (SLP’s) bill CPT codes 97110 (therapeutic exercise), 97112 (neuromuscular reeducation) and 97530 (therapeutic activities) instead of CPT codes 92507 (treatment of speech, language, voice, communication, and/or auditory processing; individual), 92508 (treatment of speech, language, voice, communication, and/or auditory processing; group) and/or 92526 (treatment of swallowing dysfunction and/or oral function for feeding)? According to the National Correct Coding Initiative (NCCI)

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01/31/18

2018 Therapy Cap Questions & Answers

With the 2018 therapy cap now beginning its 5th week, I am still receiving many questions concerning the therapy cap. In this article, I will answer the following questions: What is the 2018 therapy cap dollar threshold? How is the amount that is applied to the annual therapy cap dollar threshold calculated? How does the annual Part B deductible impact the annual therapy cap? What is the current status of the therapy cap exception process (ie. use of KX modifier)? What is the current status of the $3700 manual medical review threshold? What settings does the therapy cap apply to?

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01/29/18

2018 Therapy Cap as of January 29, 2018

The House of Representatives and the Senate have failed to act to pass legislation to either repeal the outpatient therapy cap or to extend the therapy cap exception process for Medicare beneficiaries receiving outpatient physical and/or occupational therapy as well as speech-language pathology services in calendar year 2018. So what does this mean for providers of therapy services and their Medicare beneficiaries who started receiving outpatient therapy services the first week of 2018 and continue those services this week (week of January 29, 2018) and may exceed the $2010.00 hard therapy cap? Here is the latest! If a Medicare beneficiary

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01/29/18

Transition from Cahaba to Palmetto Occurs Today

Today, January 29, 2018, is the day Part A providers in the states of Alabama, Georgia, and Tennessee transition from Cahaba to Palmetto GBA as their Medicare Administrative Contractor. Part A providers include skilled nursing facilities, rehabilitation agencies, comprehensive outpatient rehabilitation facilities, and hospitals. This would include both Part A and Part B benefits provided to Medicare beneficiaries by these types of providers. This would include outpatient therapy services such as physical therapy, occupational therapy and speech therapy. Private practices in these states will transition to Palmetto GBA on February 26, 2018. For additional information, click HERE.

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01/25/18

Issuing a NOMNC to SNF Residents

Lately, I have been receiving questions from therapists who practice in home health agencies, comprehensive outpatient rehabilitation facilities and skilled nursing facilities asking if they must issue a Notice of Medicare Non-Coverage (NOMNC) to Medicare beneficiaries who were receiving either Part A or Part B services from their organization, but now those services are ending. In this article, I will explain when a NOMNC is and is not required to be provided to a Medicare beneficiary who is having services provided by a home health agency, comprehensive outpatient rehabilitation facility, or skilled nursing facility. and those services are ending. In

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