October 2019 TRICARE Update

On December 20, 2018, the Department of Defense (DoD) released the long awaited proposed rule to add physical therapist assistants (PTAs) and occupational therapy assistants (OTAs) as TRICARE authorized providers. TRICARE accepted comments on the proposed rule until February 19, 2019. As of the date of this article being published, we I hope you found…

Billing Scenario’s for PT & OT: Part 1

This week, I will provide 3 billing scenario’s that can be applicable to either outpatient physical therapy or outpatient occupational therapy services and provide the billing answer for Medicare beneficiaries and those insurance carriers that follow the Medicare Program billing rules (i.e. “8-minute rule) and will also provide the billing answer for those insurance carriers…

Documentation Requirements to Support Therapy Above the Medicare Threshold

A question I am often asked is what are the documentation requirements that the Centers for Medicare and Medicaid Services (CMS) requires to support outpatient physical, occupational and/or speech therapy services above the annual therapy dollar threshold. The answer is there

Palmetto Active Medical Reviews

Palmetto has published an updated list of active medical reviews. Pertaining to outpatient therapy, 2 of the active medical reviews include CPT code 97110 (therapeutic exercise) and 97140 (manual therapy) provided in non-private practice settings. It’s important to document not just what the patient performed in therapy that visit, but what did the therapist or…

Noridian to Host Outpatient Therapy Webinar

The Noridian Provider Outreach and Education (POE) staff is hosting the Outpatient Therapy Services webinar on October 30, 2019 at 11 a.m. CT. This event includes: Overview What is a Certification Documentation Signatures Timed Codes Common errors Resources To sign up for this webinar or other events of interest, visit the Noridian Schedule of Events.

Prior Authorization Requirements for Florida

If you provide outpatient physical, occupational and/or speech therapy services in the state of Florida to patients who are covered by UnitedHealthcare Community Plan of Florida, you will want to read this article. Prior authorization requirements for Florida effective

Can I Charge a Medicare Patient a Cancel or No Show Fee

A question I often receive is can I bill a Medicare beneficiary who is under an outpatient therapy plan of care a cancel or no show fee (missed appointment fee)? The answer may surprise you. According to the Centers for Medicare and Medicaid Services (CMS), Medicare Claims

IRF Provider Preview Reports Now Available

The Centers for Medicare and Medicaid Services (CMS) has announced that the Inpatient Rehabilitation Facility (IRF) Provider Preview Reports have been updated and are now available. Per CMS, “the data contained within the Preview Reports is based on quality data submitted by IRFs between Quarter 2 – 2018 and Quarter 1 – 2019 and reflects…

Speech Therapy Billing: Questions and Answers

It has been awhile since I have written an article focused on outpatient speech therapy and billing. So this week, I thought I would provide answers to some of the more common questions I receive about billing for speech therapy services. The answers I provide are based on what the Medicare Part B program allows…

Work Hardening CPT Codes: Must I Be One-on-One With the Patient

A question I am often asked is must the therapist or assistant be one-on-one when providing work hardening or conditioning to a patient? There are 2 CPT codes that describe work hardening/conditioning used by physical and occupational therapists. The codes and descriptors are as follows: CPT code 97545 – Work hardening/conditioning; initial 2 hours CPT…