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12/17/14

New Subsets of Modifier 59 Not Being Implemented in Outpatient Therapy Settings

The Centers for Medicare and Medicaid Services (CMS) has responded to an inquiry by the American Physical Therapy Association, American Occupational Therapy Association and the American Speech-Language-Hearing Association as to when and whether physical therapists, occupational therapists and speech-language pathologists should use a new subset of modifiers that CMS announced in August 2014. At this time, CMS states for providers of outpatient therapy services to

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12/12/14

Multiple Procedure Payment Reduction

The Centers for Medicare and Medicaid Services (CMS) implemented the Multiple Procedure Payment Reduction (MPPR) policy in 2011 to outpatient therapy services provided to Medicare beneficiaries seen by one or more disciplines on the same day by the same private practice or non-private practice setting (i.e. same group NPI number or Tax ID number). I am often asked how the MPPR is applied and to what CPT codes does the MPPR apply to. I will answer those 2 questions below and provide you with a reference document from CMS detailing which CPT codes the MPPR does apply to when billed

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12/12/14

Modifier 59 Use in Outpatient Therapy

I receive many questions on the use of modifier 59 for outpatient therapy services. A few common questions I receive are “What is the definition of modifier 59?, When can I use modifier 59?” and my favorite “I have been told by my billing people that I can only use modifier 59 if I see the patient for 2 visits on the same day, not during a single visit, is that true?” I am going to answer the above 3 questions plus provide you with a document from the Centers for Medicare and Medicaid Services (CMS) that will support my

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12/03/14

Announcing our Friends and Colleagues Affiliate Program

Join the Gawenda Seminars Friends & Colleagues Affiliate Program, and get your Virtual Showroom (VSR). It’s simple: Top Affiliate (you/your clinic) You earn 20% commission on all sales from your website. 1st Sub-Affiliate (your friends or colleagues that you refer) They earn 20% commission on all sales from their website. You’ll earn 4% commission from all sales from their website. 2nd Sub-Affiliate (their friends or colleagues that they refer) They earn 20% commission on all sales from their website. You’ll earn 1% commission from all sales from their website. You’ll partner with one of the nations premiere medical and rehabilitation

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11/24/14

2015 Therapy Cap Values & Annual Update to the Therapy Code List

The Centers for Medicare & Medicaid Services (CMS) issued 2 transmittals providing details regarding the 2015 therapy cap dollar threshold and updating the annual therapy code list of which CPT codes will be considered “always therapy codes” or “sometimes therapy codes” and apply to the 2015 therapy cap dollar threshold. To access the transmittals, click

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11/15/14

2015 PQRS Changes

The Centers for Medicare and Medicaid Services (CMS) has finalized their changes to the 2015 PQRS program for physical and occupational therapists in private practice. Besides changes in the number of measures that must be reported, CMS is also implementing the requirement that if a physical or occupational therapist in private practice sees at least one Medicare patient in a face-to-face encounter, that they must report on at least one cross-cutting PQRS measure. The changes to the 2015 PQRS program, in addition to a listing of the new cross-cutting PQRS measures, are summarized below:

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11/15/14

Medicare Enrollment Guidelines for Ordering/Referring Providers

The Centers for Medicare and Medicaid Services has published a fact sheet titled “Medicare Enrollment Guidelines for Ordering/Referring Providers” that is designed to provide education on the Medicare enrollment requirements for eligible ordering/referring providers. It includes information on the three basic requirements for ordering and referring and who may order and refer for Medicare Part A Home Health Agency, Part B, and Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) beneficiary services.This is important information for physical therapists, occupational therapists and speech-language pathologists in private practice as well as those who practice in a facility setting such as a hospital

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11/15/14

Inpatient Rehabilitation Facility Payment Fact Sheet Revised

The “Inpatient Rehabilitation Facility Prospective Payment System” Fact Sheet (ICN 006847) was revised and is now available in downloadable format. This fact sheet is designed to provide education on the Inpatient Rehabilitation Facility (IRF) Prospective Payment System (PPS). It includes the following information: background, elements of the IRF PPS, payment updates, and IRF Quality Reporting Program. To access the Fact Sheet, click

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