The Centers for Medicare and Medicaid Services (CMS) Quality Payment Program (QPP) does provide an opportunity for qualifying clinicians and groups to apply for exceptions to meeting the Merit-based Incentive Payment System (MIPS) program requirements. The exception that most likely impacts most MIPS eligible clinicians in Performance Year 2020 is the “Extreme and Uncontrollable Circumstances […]
UnitedHealthcare Oxford has revised its clinical policy for “Outpatient Physical and Occupational Therapy”. The effective date of this revision is July 1, 2020. This policy applies to all Oxford membership excluding New Jersey Small Plan membership. To access the revised policy, click In addition, UnitedHealthcare Oxford has revised its clinical policy for Physical, Occupational, and […]
On June 25, 2020, the Centers for Medicare and Medicaid Services (CMS) released “Medicare and Medicaid Programs: CY 2021 Home Health Prospective Payment System Rate Update; Home Health Quality Reporting Requirements; and Home Infusion Therapy Services Requirements“. Per the summary, “This proposed rule would update the home health prospective payment system(HH PPS) payment rates and […]
Due to the Public Health Emergency due to the COVID-19 pandemic, the Centers for Medicare and Medicaid Services has issued many waivers regarding how hospitals can deliver outpatient therapy services to their Medicare Part B beneficiaries. In this article, I will discuss the “Hospitals without Walls” and the expansion of telehealth services and explain the […]
Extending Telehealth DeadlineOn June 16, 2020, UnitedHealthcare (UHC) announced they will extend telehealth coverage through I hope you found this update informative. Thank you for being a Gold Member!
The Centers for Medicare and Medicaid Services (CMS) developed the National Correct Coding Initiative (NCCI) edits to combat improper coding that would then lead to inappropriate payment in Medicare Part B claims. CMS owns the NCCI program and is responsible for all decisions regarding its contents. Capital Bridge, LLC is CMS’ contractor for the NCCI. In […]
Effective January 1, 2020, there were 2 new CPT codes to describe dry needling. They are as follows: 20560 – Needle insertion(s) without injection(s), 1 or 2 muscle(s) 20561 – Needle insertion(s) without injection(s), 3 or more muscle(s) Unfortunately, the Centers for Medicare and Medicaid Services (CMS) gave these 2 CPT codes a non-covered status […]
I receive many questions about the TRICARE program and thought I would take the time to write an article and provide answers to the questions I receive. If you have additional questions about TRICARE and outpatient therapy, please post them below in the comment box and if appropriate, I’ll add the question and answer to […]
Mr. Gawenda has presented nationally since 2004 and currently presents approximately 100 dates per year around the United States.