Institutional Outpatient Therapy Claims Being Denied
Institutional outpatient therapy providers are experiencing claims being denied by their Medicare Administrative Contractor (MAC) beginning on and after April 1, 2023 for claims received by the MAC. In this article, I will answer the following questions:
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What should be done if patients are being seen via Direct Access (no referring physician)?
Medicare does not recognize direct access. Here is an article I published about 4.5 years ago.
https://gawendaseminars.com/medicare-recognize-direct-access/
Does this also apply to hospital based outpatient rehab facilities?
If billing on a UB-04 claim form, yes.