Inpatient Rehabilitation Facility Billing Requirements

Due to a recent report by the Office of the Inspector General that found payments for Inpatient Rehabilitation Facility (IRF) services did not comply with Medicare billing requirements, CMS developed the IRF Prospective Payment System booklet as well as additional resources in assisting IRFs become more compliant with IRF billing. To access these resources, click…

CMS Releases FY 2020 SNF Final Rule

The Centers for Medicare and Medicaid Services (CMS) has released the Fiscal Year 2020 final rule for the Prospective Payment System (PPS) and Consolidated Billing for Skilled Nursing Facilities (SNF). This final rule finalizes the new payment system, Patient Driven Payment Model (PDPM), that goes into effect with dates of service on and after October…

Skilled Nursing Facility 3-Day Rule Billing

Due to a recent finding by the Office of the Inspector General (OIG) finding that the Medicare program improperly paid for Skilled Nursing Facility (SNF) services when the Medicare 3-Day inpatient hospital stay requirement was not met, the Centers for Medicare and Medicaid Services (CMS) has developed a Fact Sheet to explain the SNF 3-day…

MIPS 2020: Proposed Rule

On July 29, 2019, the Centers for Medicare and Medicaid Services (CMS) released the proposed rule for services paid under the Medicare Physician Fee Schedule and Other Changes to Part B Payment Policies as well as Updates to the Quality Payment Program. The latter would include the Merit-Base Incentive Payment System (MIPS). Remember that only…

CMS Issues IRF FY 2020 Final Rule

On July 31, 2019, the Centers for Medicare and Medicaid Services (CMS) issued the final rule for Fiscal Year (FY) 2020 for Inpatient Rehabilitation Facilities (IRFs). CMS projects that FY 2020 payments to IRF’s will increase by 2.5% compared to FY 2019. In the final rule, highlights of issues addressed by CMS include: Case-Mix Group…

CMS Releases Proposed Rule for Calendar Year 2020

On July 29, 2019, the Centers for Medicare and Medicaid Services (CMS) released the proposed rule for calendar year (CY) 2020 for services paid under the Medicare Physician Fee Schedule (MPFS). This proposed rule does impact providers of outpatient physical, occupational and speech therapy services in all outpatient therapy settings that does include private practices,…

UnitedHealthcare Community Plan Implements Prior Authorization for Therapy

UnitedHealthcare Community Plan has announced they will implement prior authorization for outpatient physical, occupational and speech therapy services in select states beginning as early with dates of service on and after August 1, 2019. In addition, UnitedHealthcare Community Plan has announced they will be conducting site of service medical necessity reviews for all speech, occupational…

UHC Community Plan Coverage Determination Guideline

UnitedHealthcare Community Plan has issued a revised coverage determination guideline for outpatient physical and occupational therapy. This policy applies to the following 12 states:

CMS Proposes to Cover Acupuncture for CLBP

On July 15, 2019, the Centers for Medicare & Medicaid Services (CMS) released a proposal to cover acupuncture for Medicare patients with chronic low back pain (CLBP) who are enrolled participants either in clinical trials sponsored by the National Institutes of Health (NIH) or in CMS-approved studies. To read the proposed decision memo, click HERE.…

Anthem Blue Cross Further Delays Implementation of AIM Specialty Health

Anthem Blue Cross has announced they will further delay the implementation of AIM Specialty Health and the prior authorization process for outpatient therapy services for the 13 states that were originally scheduled to begin with dates of service on and after July 1, 2019. On July 2, Anthem Blue Cross announced the implementation that began…