I often receive questions from providers of outpatient therapy services who see Medicare beneficiaries that have Medicaid as their secondary wondering if they can bill the patient for the 20% that Medicare does not pay since either they, the provider, don’t participate with Medicaid or Medicaid is not paying the 20% of the Medicare allowed amount. The simple answer is

The Office of the Inspector General (OIG) has issued a report recommending the Centers for Medicare and Medicaid Services (CMS) accelerate their efforts to implement a new method for paying for therapy services.  A new payment method may eliminate the need for the new assessments by basing payments on beneficiary characteristics rather than on the amount of therapy provided. In the meantime, CMS should mitigate the problems with the new therapy assessments by (1) reducing the financial incentive for SNFs to use assessments differently when decreasing and increasing therapy and (2) strengthening the oversight of SNF billing for changes in

I am often asked by therapists, office managers, biller’s, billing companies, etc., if the application of the KX modifier is allowed for Medicare beneficiaries who have exceeded $3700 physical and speech therapy combined in a calendar year or a separate $3700 for occupational therapy in a calendar year. Providers of therapy services are under the impression that Medicare beneficiaries have 2 therapy caps, one at $1940 in calendar year 2015 and a second therapy cap at $3700. Providers are also under the impression that once a Medicare beneficiary exceeds $3700, the KX modifier is no longer allowed to be applied

The past 2 weeks, I wrote on 2 primary reasons why a provider may have to issue an advance beneficiary notice of noncoverage (ABN) to a Medicare beneficiary receiving outpatient therapy services. In this week’s article, I am going to teach providers how to complete the ABN form and provide examples of completed ABN forms. The Centers for Medicare and Medicaid Services (CMS) has an ABN form, CMS-R-131, on their website that suppliers and providers can use to notify Medicare beneficiaries of expected noncoverage of a service or services provided. If suppliers and providers wish to, they can develop their

In last week’s article, I provided one of the main reasons when a provider would need to issue an advance beneficiary notice of noncoverage (ABN) to a Medicare beneficiary receiving outpatient therapy services. To see last week’s article, click HERE. In today’s article, I am going to explain why a provider would need to issue an ABN to a Medicare beneficiary that requires iontophoresis as part of their therapy plan of care. First, lets answer the question “Does the Medicare program cover iontophoresis”? The answer is yes. Nationally, the Medicare program does cover and pay for iontophoresis. So you might

The Centers for Medicare and Medicaid Services (CMS) conducted their second ICD-10 end-to-end testing the week of April 27 – May 1, 2015 and the results released today show CMS is ready for the implementation of ICD-10 on October 1, 2015. Approximately 875 providers, clearinghouses and billing agencies accounting for nearly 1600 registered NPI’s participated in the testing week. The acceptance rate for April was higher than January, with an increase in test claims submitted and a decrease in the percentage of errors related to both ICD-9 and ICD-10 diagnosis codes. • 23,138 test claims received • 20,306 test claims

In last week’s newsletter, I provided the answers to the following 3 questions regarding routine ABN’s: Can we have all of our Medicare patient’s sign an advance beneficiary notice (ABN) on their initial appointment to protect us in case our Medicare Administrative Contractor (MAC) denies any of our services as not medically necessary? Once a Medicare beneficiary reaches the annual therapy cap dollar threshold ($1940 for physical therapy and speech therapy combined and a separate $1940 for occupational therapy in calendar year 2015), can I have the Medicare beneficiary sign an ABN even though I feel the therapy services are

Wisconsin Physician Services (WPS) will host a webinar on Coverage Criteria and Documentation on June 18, 2015 in East Lansing, MI. The seminar will explore the coverage criteria and documentation requirements for physical therapy, occupational therapy, and speech language pathology. In this interactive session we will review the coverage criteria as well as actual documentation examples. For additional information and to register, click HERE. Wisconsin Physician Services (WPS) will host a billing and payment seminar on June 18, 2015 in East Lansing, MI. The seminar will include the following: CMS regulations and coverage, resources to understand the billing and payment, Advance