The Centers for Medicare and Medicaid Services (CMS) will host a special Open Door Forum on Tuesday, June 14, 2016 from 2:00pm – 3:00pm ET on the Pre-Claim Review Demonstration for Home Health Services. Special Open Door Forum Participation Instructions: Participant Dial-In Number: 1-800-837-1935 Conference ID #: 94873140 For additional information, click HERE.

In 2015, home health claims had a 59 percent improper payment rate, and a large proportion of the improper payment rate was because of insufficient documentation. The Centers for Medicare and Medicaid Services (CMS) is going to implement a pre-claim review demonstration of home health services in 5 states to help educate Home Health Agencies (HHA) on what documentation is required and encourage them to submit the correct documentation, while still allowing the HHA to begin providing services and receive initial payments prior to the pre-claim review decision. For additional information on how the pre-claim review process will work and

StrategicHealthSolutions (SHS), LLC was awarded as the Supplemental Medical Review Contractor (SMRC), a Specialty Medical Review Contractor, supporting the Centers for Medicare and Medicaid Services (CMS). The SMRC will perform and/or provide support for a variety of tasks aimed at lowering the improper payment rates and increasing efficiencies of the medical review functions of the Medicare and Medicaid programs. The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) extended the outpatient therapy cap exception process until December 31, 2017 and modified the requirement for manual medical review for services over the $3700 therapy thresholds. One of the tasks SMRC

The Centers for Disease Control and Prevention (CDC) has released ICD-10-CM proposed coding changes for October 1, 2016. To date, there are potentially 1943 new ICD-10-CM codes, 422 diagnosis codes with revised definitions, and 305 codes that will probably be deleted. The public comment period for these planned updates closed on April 8, 2016. Both the Centers for Medicare & Medicaid Services (CMS) and the CDC will review all comments before issuing the final list of new, revised and deleted diagnosis codes in June 2016. Regarding sequela of cerebrovascular disease and cognitive deficits, here is a sampling of some of the

The Centers for Disease Control and Prevention (CDC) has released ICD-10-CM proposed coding changes for October 1, 2016. To date, there are potentially 1943 new ICD-10-CM codes, 422 diagnosis codes with revised definitions, and 305 codes that will probably be deleted. The public comment period for these planned updates closed on April 8, 2016. Both the Centers for Medicare & Medicaid Services (CMS) and the Centers for Disease Control and Prevention (CDC) will review all comments before issuing the final list of new, revised and deleted diagnosis codes in June 2016. Regarding pelvic health, here is a sampling of some of

Effective for dates of service on or after May 1, 2016, policy for physical therapy (PT), occupational therapy (OT), and speech therapy (ST) will change for the Texas Medicaid Comprehensive Care Program (CCP). Some of the key policy changes include: Chronic therapy services will only be offered to clients who are birth through 20 years of age. The authorization period for chronic therapy services will be 180 days. Reevaluations require authorization and are part of the authorization/recertification process for chronic therapy service, and they will only be reimbursed when appropriate and when submitted with a recertification request. A standardized test

Over the last several weeks, I have written articles on Reevaluations vs Progress Reports: What’s the Difference?, Progress Reports: What are the Required Elements?, and Progress Reports vs Recertifications: What’s the Difference? This week, I want to discuss is it possible for one note to include the required elements for a progress report, reevaluation and a recertification and if yes, how would the note look and would a physician need to sign and date the note. To answer the question, yes, one note can contain the required elements for a progress report, reevaluation and a recertification for Medicare Part B

I am often asked how many units can I bill a patient on a particular date of service. Another question I often received are from therapists who do lymphedema and want to know how many units of manual therapy they can bill during a visit. The answer to the above questions is that it is insurance carrier specific. There are insurance carriers that limit how many units may be billed and paid during a single visit as well as may limit the amount of units of a particular CPT code they will pay for during a single date of service.