Effective June 4, 2015, The Centers for Medicare and Medicaid Services (CMS) has withdrawn the Requests for Quotes for the next round of Recovery Auditor contracts. CMS plans to update the Statement of Work and release new Requests for Proposals shortly. In the meantime, the current Recovery Auditors will continue active recovery auditing through at least December 31, 2015. In addition, in mid-January 2015, CMS approved the Recovery Auditors to begin reviewing Outpatient Therapy Threshold claims (those over the $3700 threshold) that were paid March 1, 2014 through December 31, 2014. In an effort to minimize provider burden, CMS set restrictions

Noridian Healthcare Solutions will be hosting a workshop on August 25, 2015 on signature requirements under the Medicare program. The workshop will include: Overiew and Purpose Valid Signatures Signature Guidelines Attestation Form and Signature Log Comprehensive Error Rate Testing (CERT) Resources Questions For additional information and to register, click HERE.

Noridian Healthcare Solutions will be hosting a workshop on the Medicare therapy cap exception process on August 6, 2015. The workshop will include: Therapy Cap Exception Process Accessing Therapy Limits Required Documentation Claim Submission KX Modifier Overview For additional information and to register, click HERE.

On July 15, 2015, the Centers for Medicare and Medicaid Services (CMS) released the 2016 proposed rule for services reimbursed under the Medicare Physician Fee Schedule (MPFS). This proposed rule does impact outpatient therapy services provided in the following settings: Private Practice Skilled Nursing Facilities Outpatient Rehabilitation Facilities Comprehensive Outpatient Rehabilitation Facilities Home Health Agencies providing Part B Therapy Services Hospital Outpatient Departments (excludes critical access hospitals) Highlights of the proposed rule include the 2016 payment rate, 2016 PQRS program, and CPT codes used by PT and OT that CMS wants to review to see if they are “misvalued” and

With less than three months remaining until the nation switches from ICD-9 to ICD-10 coding for medical diagnoses and inpatient hospital procedures, The Centers for Medicare & Medicaid Services (CMS) and the American Medical Association (AMA) are announcing efforts to continue to help physicians get ready ahead of the October 1 deadline. In response to requests from the provider community, CMS is releasing additional guidance that will allow for flexibility in the claims auditing and quality reporting process as the medical community gains experience using the new ICD- 10 code set. To read the additional guidance that does include an

The Centers for Medicare and Medicaid Services (CMS) has issued a proposed new payment model that would bundle payment to acute care hospitals for hip and knee replacement surgery. Hip and knee replacements are the most common inpatient surgery for Medicare beneficiaries and can require lengthy recovery and rehabilitation periods. In 2013, there were more than 400,000 inpatient primary procedures costing more than $7 billion for hospitalization alone. The average Medicare expenditure for surgery, hospitalization, and recovery ranges from $16,500 to $33,000 across geographic areas. Under this proposed model, the hospital in which the hip or knee replacement takes place

There was a payment issue with Palmetto GBA, Medicare Administrative Contractor for the states of North Carolina, South Carolina, Virginia and West Virginia, with the billing of CPT code 97140, manual therapy. Palmetto was denying payment for manual therapy (97140) unless it was billed with ICD-9 codes 457.0 (postmasectomy lymphedema syndrome), 457.1 (other lymphedema), and 757.0 (hereditary edema of legs). The denials are occurring due to a Local Coverage Article (on Manual Lymphatic Drainage Therapy (A53477)) that went into effect around June 18. Update today is that Palmetto has posted an article stating that Palmetto GBA has determined that Part

Wisconsin Physician Services will be hosting a therapy billing and payment seminar on July 15th in Portland, Oregon. The agenda will include: CMS Regulations and Coverage Resources to Understand the Billing and Payment Advance Beneficiary Notice of Noncoverage Functional Reporting Criteria The fee for this event is $65.00 per person. We now accept payments via check and credit cards through PayPal. Registration will close on 07/08/15 or when capacity is reached. Payment is due by 07/10/15. You may register up to 4 people per registration.  If you wish to register more, please complete another registration form. You may mail one