On October 6, 2014, the Centers for Medicare and Medicaid Services (CMS) released a proposed rule detailing revisions to the Conditions of Participation for Home Health Agencies. This proposed rule represents the first update to the Home Health Agency Conditions of Participation since 1989. According to the CMS website, the provisions of the proposed rule include: Includes revisions to the Outcomes and Assessment Information Set (OASIS) requirements to update applicable electronic data transmissions to meet current federal standards. Expands the current patient rights requirements to clarify the rights of each patient, the process for conducting patient rights violation investigations, and

The Centers for Medicare and Medicaid Services has revised the Medicare Appeals Process fact sheet. This fact sheet is designed to provide education on the five levels of claim appeals in Original Medicare (Medicare Part A and Part B). It includes details explaining how the Medicare appeals process applies to providers, participating physicians, and participating suppliers, in addition to including more information on available appeals-related resources. To access the fact sheet, click

The Centers for Medicare and Medicaid Services has issued revised instructions how to complete Form CMS-1500, Form Version 02/12. This is the form that is used by physical therapists, occupational therapists and speech-language pathologists who are in private practice to submit claims to Medicare for payment of outpatient therapy services. To access the revised instructions,

Per the Centers for Medicare & Medicaid Services (CMS), standard system editing for Therapy Functional Reporting (THFR) claims has been revised. Providers should re-submit all THFR claims that may have been denied/rejected due to a missing discharge code. This is applicable to both original claim submissions as well as claim adjustments. CMS will continue to monitor the THFR reporting and will issue further instructions regarding THFR as necessary.

Noridian Healthcare Solutions, Medicare Administrative Contractor for the states of Alaska, Arizona, Idaho, Montana, North Dakota, Oregon, South Dakota, Utah, Washington, and Wyoming, has released Functional Limitation Reporting (i.e. Medicare G codes) frequently asked questions (FAQs). To access the FAQs, Gold Members log in or non-members, become a Gold Member. For private practices, click

Private practices and institutional settings (i.e. hospitals, SNF’s, Rehab Agencies, CORF’s and Home Health Agencies) may be providing 60 days of uncompensated outpatient therapy services and not even realize it. This is due to a provision in the Affordable Care Act (ACA) called the ‘grace period”. Here is how it works.

With approximately 15 million Medicare beneficiaries enrolled in Medicare Advantage plans under Medicare Part C, I am often asked if the Medicare Advantage plans follow the same rules as traditional Medicare for outpatient therapy services in terms of Functional Limitation Reporting, the application of the Multiple Procedure Payment Reduction policy, PQRS for private practices, CCI edits and the use of modifier-59, using the therapy specific modifiers (i.e. GN, GO, GP), and the application of the Medicare therapy cap, just to name a few. While Medicare Advantage plans must follow certain federal guidelines, they are offered by private insurance carriers such

First Coast Service Options has released their August 2014 Medicare Connection newsletter for both private practices and institutional settings. For institutional providers (i.e.non-private practices), click HERE to access the newsletter. This newsletter discusses adjustments of hospital outpatient therapy claims as well as electronic claims reopenings. For private practices, click HERE to access the newsletter. This newsletter discusses clarification of the “confined to the home” definition as well as ICD-10 testing opportunities.