On July 19, 2021, UnitedHealthcare (UHC) Medicare Advantage announced their continued expansion of telehealth access, including temporarily waiving the Centers for Medicare & Medicaid Services (CMS) originating site requirements. UHC will extend the expansion of telehealth access for in-network and out-of-network providers I hope you found this article helpful. Thank you for being a Gold […]
On July 19, 2021, Xavier Becerra, Secretary of Health and Human Services, renewed the Public Health Emergency (PHE) due to COVID-19 with an effective date of July 20, 2021. The PHE will now end at the end of the day on October 17, 2021. Due to this extension, the Centers for Medicare and Medicaid Services (CMS) will […]
On July 13, 2021, the Centers for Medicare and Medicaid Services (CMS) released the calendar year (CY) 2022 proposed rule for services reimbursed under the Medicare Physician Fee Schedule (MPFS). This rule does apply to outpatient physical, occupational and speech therapy services provided in all outpatient therapy settings except a critical access hospitals. This proposed […]
In this article, I will explain the 4 sets of modifiers that could be applicable to the advance beneficiary notice of non-coverage (ABN) form that is used for traditional Medicare beneficiaries. QuestionWhat are the advance beneficiary notice of non-coverage modifiers? Answer QuestionWhat is the description of each of the modifiers? Answer QuestionWhen would I use […]
UnitedHealthcare (UHC) Individual Exchange Plan has announced they will begin requiring additional modifiers be appended to CPT codes on both the 1500-claim form and UB-04 claim form in order for outpatient therapy services to be reimbursed. Failure to append the new modifiers on each CPT code will result in those claim lines being rejected. The […]
UnitedHealthcare (UHC) Commercial and UHC Oxford have updated their Coverage Determination Guideline for speech generating devices with an effective date of July 1, 2021. To access the updated policy for UHC Commercial, click. To access the updated policy for UHC Oxford, click In addition, UHC Community plan has developed a Coverage Determination Guideline for speech […]
As some physical therapists, occupational therapists and speech-language pathologists continue to specialize in the services they provide, a question I am often asked is do insurance carriers, especially the Medicare program, allow a beneficiary to attend therapy (same discipline or different disciplines) at more than one location during the same time period and reimburse both […]
Many provides have a good understanding of the National Correct Coding Initiative (NCCI) edits utilized by the Centers for Medicare and Medicaid Services (CMS) as well as other commercial insurance carriers, including some workers compensation carriers. However, most providers of outpatient therapy services are either unaware or lack a solid understanding of CMS’ medically unlikely […]
Mr. Gawenda has presented nationally since 2004 and currently presents approximately 100 dates per year around the United States.