I’m OON! What are the Pros and Cons of Submitting a Claim to the Insurer?
As a private practice owner, you have made the decision to go out-of-network (OON) with an insurer. You are now trying to identify the benefits and risks of submitting a claim to the insurer or providing the patient with a superbill. In this third article of this 3-part series, I will answer the following questions:
I’m OON! What are My Options of Submitting Claims to the Insurer?
As a private practice owner, you have made the decision to go out-of-network (OON) with an insurer. You are now trying to understand the different options of submitting a claim to the insurer or providing the patient with a superbill. In this second article of a 3-part series, I will answer the following questions:
CMS Releases IRF FY 2026 Proposed Rule
On April 11, 2026, the Centers for Medicare and Medicaid Services (CMS) released the Inpatient Rehabilitation Facility (IRF) Fiscal Year (FY) 2026 proposed rule. Highlights of the proposed rule include: To access the IRF FY 2026 proposed rule, click HERE. To access the IRF FY 2026 proposed rule Fact Sheet, click HERE.
CMS Releases SNF FY 2026 Proposed Rule
On April 11, 2026, the Centers for Medicare and Medicaid Services (CMS) released the Fiscal Year (FY) 2026 Skilled Nursing Facility (SNF) proposed rule. HIghlights of the proposed rule include: To access the SNF FY 2026 proposed rule, click HERE. To access the SNF FY 2026 proposed rule Fact Sheet, click HERE.
Should I Go Out-of-Network?
With stagnant or decreasing reimbursement and rising expenses, more practices are considering going out-of-network (OON) with some insurers. However, what information must owners consider when making this decision? In this article (Part 1 of 3), I will answer the following questions:
Writing a Discharge Report on a Patient You Never Treated
A therapist (employee or traveler) has left your practice or organization. After they left, you realize this therapist had 1 or more medical records they did not write a discharge report on. A question I am often asked is can another therapist that is employed by the practice or organization who never treated this patient write the discharge report based on the existing documentation in the medical record? The answer is
Medicare NCCI Edits Version 31.1
The Centers for Medicare and Medicaid Services (CMS) has released the National Correct Coding Initiative (NCCI) edits Version 31.1 for original Medicare. Version 31.1 will be in effect for dates of service April 1, 2025 – June 30, 2025. To access Gawenda Seminars outpatient therapy specific NCCI edit reference sheet for original Medicare, click HERE. There is one version for private practices and a different version for nonprivate practices. Be sure to be logged into your account.
Medicaid NCCI Edits Version 31.1
The Centers for Medicare and Medicaid Services (CMS) has released the National Correct Coding Initiative (NCCI) edits Version 31.1 for original Medicaid. Version 31.1 will be in effect for dates of service April 1, 2025 – June 30, 2025. To access Gawenda Seminars outpatient therapy specific NCCI edit reference sheet for Medicaid, click HERE. There is one version for private practices and a different version for nonprivate practices. Be sure to be logged into your account.