Wisconsin Physician Services (WPS) will be providing a teleconference on October 1, 2014 on documenting medical necessity for major joint replacements (hips and knees). This educational event is intended to improve compliance with documentation requirements for major joint replacement surgery. For additional information and to register, click HERE.

The Centers for Medicare and Medicaid Services (CMS) is establishing four new Healthcare Common Procedure Coding System (HCPCS) modifiers to define subsets of the -59 modifier, a modifier used to define a “Distinct Procedural Service.” Currently, providers can use the -59 modifier to indicate that a code represents a service that is separate and distinct from another service with which it would usually be considered to be bundled. Because it can be so broadly applied, some providers incorrectly consider it to be the “modifier to use to bypass National Correct Coding Initiative (NCCI)”, it is the most widely used modifier.

The Centers for Medicare and Medicaid Services has provided clarification of the “Confined to the Home” definition in order for Medicare beneficiaries to receive home health services. To read the clarification instructions, click

A study assessing the outcomes of patients who were treated in inpatient rehabilitation facilities (IRFs) with clinically and demographically similar patients who received their post-acute rehabilitation in skilled nursing facilities (SNFs) finds that IRFs provide better care to their patients over a number of outcome measures – IRF patients live longer, spend more days at home and fewer days in health care institutions, have fewer emergency room visits and, for patients with some diagnoses, fewer rehospitalizations. The study has significant implications for site-neutral payment proposals and bundling demonstrations, both of which are likely to shift patients to SNFs. To read

Wisconsin Physician Services (WPS) will host a half-day seminar designed to discuss complex MDS concepts on September 10, 2014 in Fort Wayne, IN. During this seminar, WPS will discuss topics such as:  therapy OMRAs (Other Medicare Required Assessments); early, late or missing assessments; complex MDS billing scenarios; current findings related to MDS 3.0 submission; and tools available to aid MDS coordinators. For additional information and to register, click HERE.

On July 31, 2014, the Department of Health and Human Services issued a rule finalizing October 1, 2015 as the new compliance date for health care providers, health plans, and health care clearinghouses to transition to ICD-10. The rule was published in the Federal Register on August 4, 2014.

On August 6, 2014, the Centers for Medicare and Medicaid Services (CMS) issued Medicare Program; Inpatient Rehabilitation Facility Prospective Payment System for Federal Fiscal Year 2015; Final Rule. Inpatient Rehabilitation Facilities (IRFs) will receive a 2.2% increase in their FY 2015 payments compared to FY 2014. The final rule discusses revisions to the 60 Percent Rule Presumptive Compliance Criteria, definitions of individual therapy, group therapy, co-treatment therapy and concurrent therapy, and revision to the IRF-PAI for arthritis conditions. Revisions to the 60 Percent Rule Presumptive Compliance Criteria CMS finalizes its proposal to remove 10 status post-amputation diagnoses codes from the

On August 5, 2014, the Centers for Medicare and Medicaid Services (CMS) issued Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities for FY 2015; Final Rule. Payments to skilled nursing facilities (SNFs) will increase by 2% in FY 2015. This translates to an estimated additional $750 million compared to FY 2014. SNF Therapy Research Project CMS contracted with Acumen, LLC and the Brookings Institution to identify potential alternatives to the existing methodology used to pay for therapy services received under the SNF PPS. Under the current payment model, the therapy payment rate component of the SNF