The Office of Inspector General has released a report recommending that the Centers for Medicare and Medicaid Services (CMS) seek legislation to adjust Critical Access Hospital (CAH) swing-bed reimbursement rates to the lower SNF PPS rates paid for similar services at alternative facilities. CMS agreed with our finding that CAHs’ swing-bed utilization has increased but disagreed with our recommendation because of concerns with our findings on the availability of skilled nursing services at nearby alternative facilities and our calculation of savings. To read the full report, click HERE.

Modifier 59 is used in the outpatient therapy setting to identify when one intervention was provided at a separate and distinct time from another intervention to the same Medicare beneficiary during the same treatment session. Modifier 59 is not only the most commonly used modifier, but is also the most abused modifier that is utilized. Due to this, the Centers for Medicare and Medicaid Services (CMS) has defined four new HCPCS modifiers to selectively identify subsets of Distinct Procedural Services (-59 modifier). The effective date of the new subsets of modifier 59 was January 1, 2015; however, CMS has not

The Centers for Medicare and Medicaid Services (CMS) has issued additional guidance regarding the new subsets of modifier 59 (i.e. XE, XP, XS, and XU) that became effective January 1, 2015 and the continued use of modifier 59 after January 1, 2015. In the updated guidance, CMS states providers may continue to use modifier 59 after January 1, 2015 in any instance in which it was correctly used prior to January 1, 2015. Additional guidance and education as to the appropriate use of the new modifiers will be forthcoming as CMS continues to introduce the modifiers in a gradual and

I often have therapists tell me they are treating a current patient for a specific diagnosis/condition and that the patient will be returning to see their physician for a follow-up visit. The therapist tells me they wrote a Progress Report and sent it to the physician to provide the physician with the most current status of their patient. In order to write the Progress Report, the therapist not only gathered subjective comments from the patient and/or their family, but also gathered objective data, tests, and measures that included range of motion measurements and manual muscle testing. Since the therapist took

The Centers for Medicare and Medicaid Services (CMS) has released the results of the ICD-10 end-to-end testing week that was conducted from January 26, 2015 through February 3, 2015. CMS received 14,929 test claims and 12,149 were accepted for an 81% acceptance rate. Reasons for rejected claims * 3% – Invalid submission of ICD-9 diagnosis or procedure code * 3% – Invalid submission of ICD-10 diagnosis or procedure code * 13% – Non-ICD-10 related errors, including issues setting up the test claims (e.g., incorrect NPI, Health Insurance Claim Number, Submitter ID, dates of service outside the range valid for testing,

Noridian Healthcare Solutions, Medicare Administrative Contractor for the states of Alaska, Arizona, Idaho, Montana, North Dakota, Oregon, South Dakota, Utah, Washington, and Wyoming, will be hosting a Inpatient Rehabilitation Facility (IRF) – CERT Reviews and Findings workshop on March 03, 2015at 1:00 p.m. Central Time. The session includes: Inpatient Rehabilitation Facility (IRF) Services IRF Billing and Coding Guidelines IRF Documentation Requirements IRF Medical Necessity Criteria Reference Materials To sign up for this workshop or other workshops of interest, visit the Noridian “Workshops” page at https://www.noridianmedicare.com/parta/train/workshops/index.html.

Wisconsin Physician Services Medicare has noted recent Comprehensive Error Rate Testing (CERT) denials for Inpatient Rehabilitation Facility (IRF) services. In the majority of these cases, the CERT reviewer determined the documentation did not support that the patient participated in an intensive individual rehabilitation program as required by Medicare regulations. There were also instances where the plan of care (POC) did not document the expected amount of therapy time “by discipline” (physical therapy, occupational therapy, speech-language pathology, and orthotics/prosthetics). Click HERE to see some of the review determinations.

On February 11, 2015, the American Hospital Association (AHA) urged the Health Subcommittee of the Committee on Energy and Commerce of the U.S. House of Representatives to oppose any further delays to the implementation of ICD-10 scheduled for October 1, 2015. The AHA noted that 93% of hospitals surveyed this year were moderately to very confident they could meet the October 1, 2015 implementation deadline. Previous delays in the implementation of ICD-10 has cost health plans Medicare, Medicaid, hospitals and large providers anywhere from $1.2 billion and $6.9 billion. To read the AHA statement, click HERE.