Two weeks ago, I discussed the difference between a reevaluation and a progress report that is applicable to all insurance carriers, including the Medicare program. To read that article, click HERE. Last week, I discussed what the required elements are for a progress report. To read that article, click HERE. This week, I will discuss the difference between a progress report and a recertification for Medicare Part B patients. Under Medicare Part B, the Centers for Medicare and Medicaid Services (CMS) states the minimum progress reporting period shall be at least once every

The Centers for Medicare and Medicaid Services (CMS) has prepared a public data set, the Medicare Provider Utilization and Payment Data: Physician and Other Supplier Public Use File (Physician and Other Supplier PUF), with information on services and procedures provided to Medicare beneficiaries by physicians and other healthcare professionals. Other healthcare professionals include physical and occupational therapists as well as speech-language pathologists in private practice. The Physician and Other Supplier PUF contains information on utilization, payment (allowed amount and Medicare payment), and submitted charges organized by National Provider Identifier (NPI), Healthcare Common Procedure Coding System (HCPCS) code, and place of

CPT Assistant is a monthly publication from the American Medical Association (AMA) that provides information and clarification regarding proper CPT code usage. CPT Assistant can be used for the following: Improve compliance and overturn denials Validate coding to auditors Educate providers, coders, and payers Demystify confusing codes with clinical scenarios Get answers to your most frequently asked questions For additional information and to subscribe, click HERE.  

In last weeks article, Reevaluations vs Progress Reports: What’s the Difference?, I explained the difference between a reevaluation and a progress report, how the 2 terms are not the same and should not be used interchangeably and when a reevaluation is appropriate to perform and bill to an insurance carrier. This week, I want to discuss what the required elements are for a progress report under Medicare Part B as well as some private/commercial insurance carriers and how often they are required by the Medicare program. Under Medicare Part B, the Centers for Medicare and Medicaid Services (CMS) states the

On April 21, 2016, the Centers for Medicare and Medicaid Services (CMS) released the skilled nursing facility (SNF) proposed rule for FY 2017 for services reimbursed under Medicare Part A benefits. Based on the proposed rule, CMS projects payments for SNF’s will increase by 2.1% in FY 2017 compared to FY 2016. The 2017 proposed rule adds to the list of quality measures that will be required of SNFs beginning in 2018 to include data on discharge to community, Medicare spending per beneficiary, and potentially preventable 30-day readmissions. The proposal also stipulates that by 2020, SNFs will be required to

On April 21, 2016, the Centers for Medicare and Medicaid Services (CMS) released FY 2017 Inpatient Rehabilitation Facility (IRF) proposed rule. In the proposed rule, CMS is proposing to increase IRF payment by 1.45% in FY 2017 compared to FY 2016. Beginning in FY 2014, any IRF that does not submit the required data to CMS receives a 2.0 percentage point decrease in its annual increase factor for payments under the IRF PPS. The Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act) requires the continued specification of quality measures, as well as resource use and other measures, for

I often have therapists tell me that they have to do a reevaluation on all of their patient’s every 30 days from the date of the patient’s initial evaluation. I then ask them why they think that is a requirement. Their response is usually along the lines of “Medicare requires we do a reevaluation every 30 days” or “my state practice act requires we do a reevaluation every 30 days” or “my employer or my organization requires we do a reevaluation every 30 days.” In this article, I will address the above 3 responses and explain why it probably is

The Centers for Medicare and Medicaid Services (CMS) has released Skilled Nursing Facility (SNF) utilization and payment data for 2013. In addition to information on payments and charges, the SNF Payment Public Use File (PUF) contains information on two categories of RUGs for patients who receive a significant amount of therapy: Ultra-High (RU) and Very High (RV) Rehabilitation RUGs. Consistent with prior CMS findings, the SNF PUF shows that for these two RUGs, the amount of therapy provided is often very close to the minimum amount of minutes needed to qualify a patient for these categories.  Medicare SNF per diem