On November 2, 2017, the Centers for Medicare and Medicaid Services (CMS) released the final rule for services paid under the Medicare Physician Fee Schedule (MPFS). This final rule impacts providers and suppliers of outpatient physical and occupational therapy services as well as speech-language pathology services. This would include outpatient therapy services provided in the following settings: Private Practice Skilled Nursing Facility Part B Therapy Comprehensive Outpatient Rehabilitation Facility Rehabilitation Agency Home Health Doing Part B in the Home Hospital Outpatient Departments Highlights of the final rule include: 2018 annual therapy cap dollar threshold and manual medical review process New

A question I often receive regarding physician orders is how old can a physician order/referral for outpatient therapy be? Must therapy begin within 30 days, 60 days, 90 days, etc. of the order/referral being signed and dated by the referring physician? For Medicare Part B therapy services, the Centers for Medicare and Medicaid Services (CMS) does

There is a local orthopedist who owns 7-8 PT practices in my area. When we perform an Initial Evaluation on one of his Medicare patients, he refuses to sign off on our plan of care (POC) even though we have his prescription. We will follow up multiple times with his front desk staff and even have the patients contact the referring MD office. The response is that these Medicare patients must be seen at his clinic/PT office. Is that correct? A physician

On October 26, 2017, lawmakers from the House Energy and Commerce Committee, the House Ways and Means Committee, and the Senate Finance Committee announced a bipartisan agreement to end the therapy cap. This is just a proposal and must still be approved by the House of Representatives and the Senate. To access the proposal, sign in to your account or become a Gold Member! The proposal would do the following regarding the annual outpatient therapy cap and for claims exceeding $3700 in a calendar year:

The Centers for Medicare and Medicaid Services (CMS) has issued revised instructions related to signature requirements to clarify that the responsible party has accepted responsibility for the care of the beneficiary and authenticated related documentation. CMS discusses illegible signatures, signatures missing from documentation, signature log, and signature attestation statement. In the revised instructions, the CMS provides examples of when the signature requirements are met and when the MACs, CERT and ZPICs/UPICs should contact the billing provider. Lastly, the revised instructions discuss electronic signatures and signature dating requirements. To access the revised instructions, click I hope you found this article and

UnitedHealth Group offers products and services through two operating businesses, UnitedHealthcare and Optum, both subsidiaries of UnitedHealth Group. Optum include three divisions: OptumInsight – Health Data Analytic, Payment Integrity, Life Science, Risk Quality & Network Solutions, Medical Billing OptumRx – Pharmacy Benefit Manager (now includes all Unitedhealthcare membership) and Catamaran acquisition OptumHealth – Healthcare delivery services and support including Consumer Solution Group and OptumCare (Behavioral Health and Substance Abuse, Dental, Vision, Transplant Management, and other ancillary services) OptumHealth Care Solutions processes outpatient therapy claims and OptumHealth Care Solutions have several reimbursement policies pertaining to outpatient physical, occupational and speech therapy

A question I often receive is I have a patient who is insured through UnitedHealthcare, but when I submit the claim to UnitedHealthcare, it is returned to me stating I should have submitted the claim to OptumHealth. How do I know when to submit the claim to UnitedHealthcare or OptumHealth? You can determine who is processing your claims by looking at the  

A question I often receive is will insurance carriers renegotiate my fee schedule and pay me more for the outpatient therapy services I provide to their beneficiaries? Of course, this is a question I can’t give a definitive answer to, but I always recommend you try, especially if you provide services that are considered sub-specialties. Sub-specialty services could include lymphedema, pediatrics and certified hand therapy. OptumHealth states the following to providers who want to renegotiate their fee schedule: