The Centers for Medicare and Medicaid Services (CMS) has issued a proposed rule to cancel the mandatory Episode Payment Models and Cardiac Rehabilitation Incentive payment model that was scheduled to begin January 1, 2018. This would include the Surgical Hip and Femur Fracture Treatment (SHFFT) Model. In addition, the proposed rule would reduce the number of mandatory geographic areas participating in the Center for Medicare and Medicaid Innovation’s (Innovation Center) Comprehensive Care for Joint Replacement (CJR) model from 67 to 34. In addition, CMS proposes to allow CJR participants in the 33 remaining areas to participate on a voluntary basis.

According to the 2015 Comprehensive Error Rate Testing (CERT) Report, the denial rate for Skilled Nursing Facilities (SNFs) increased from 6.9% in 2014 to 11% in 2015. The majority of improper payments for SNF services were due to insufficient documentation. To access the Executive Summary, click HERE and read page 18.  

A question I often receive is what CPT codes does the so called “8-minute rule” apply to? Does it apply to just the 15-minute time-based CPT codes or does it also apply to the 1-hour time-based CPT codes as well as the untimed, supervised modality CPT codes and untimed evaluation CPT codes? The “8-minute rule” applies to all CPT codes

The Centers for Medicare and Medicaid Services has released a new booklet – NPI: What You Need to Know. In this booklet, you will learn the following: What is an NPI Benefits of an NPI What an NPI Doesn’t Do Who May Obtain an NPI Who Must Obtain an NPI Who May Not Obtain an NPI What are the Healthcare NPI Categories How Do You Apply For an NPI For the answers to all of the above, log into your account or become a Gold Member and click

I often receive questions asking if I must discharge my patient from outpatient therapy services if they are admitted to a hospital, either for a condition related to what I am treating or unrelated to the condition I am treating. In this article, I will answer this question. The Centers for Medicare and Medicaid Services (CMS) does  

Hospitals are required to deliver the Important Message from Medicare (IM), CMS-R-193 to all Medicare beneficiaries (Original Medicare beneficiaries and Medicare Advantage plan enrollees) who are hospital inpatients. The IM informs hospitalized inpatient beneficiaries of their hospital discharge appeal rights. Beneficiaries who choose to appeal a discharge decision must receive the Detailed Notice of Discharge (DND) from the hospital or their Medicare Advantage plan, if applicable. The effective date for use of the updated IM and DND is 60 days from June 29, 2017. For additional information, click HERE.

I often receive questions of what is the difference between CPT codes 97039, 97139 and 97799 and can I give an example of when a provider of therapy services would use these CPT codes. Lets first begin by defining the 3 CPT codes. According to the American Medical Association (AMA), CPT 2017 Professional, the codes are as follows: 97039 – Unlisted modality (specify type and time if constant attendance) 97139 – Unlisted therapeutic procedure (specify) 97799 – Unlisted physical medicine/rehabilitation service or procedure So, what are some examples of interventions that would be included in each of these codes? Examples

The Centers for Medicare and Medicaid Services (CMS) has clarified the instructions for amending or correcting entries in the medical record. This clarification impacts paper medical records as well as electronic medical records. The effective and implementation date of these clarifications is August 22, 2017. To view the clarifications, click