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04/18/14

NGS to Host Outpatient Therapy Webinar

National Government Services (NGS) will be hosting 3 webinars specific for their therapy providers and the webinars will review the local coverage determination, supplemental instructions article and important information for their therapy providers for 2014. The webinars will take place on April 22, May 15, and June 11.

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04/18/14

CMS Releases 2012 Payments to Therapists in Private Practice

On April 9, 2014, The Centers for Medicare and Medicaid Services (CMS) announced the release of new, privacy-protected data on services and procedures provided to Medicare beneficiaries by physicians and other health care professionals. The new data also show payment and submitted charges, or bills, for those services and procedures by provider. The new data set has information for over 880,000 distinct health care providers, including physical, occupational and speech therapists in private practice, who collectively received $77 billion in Medicare payments in 2012, under the Medicare Part B Fee-For-Service program. With this data, it will be possible to conduct

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03/31/14

Providers Must Use Revised CMS-1500 Claim Form Beginning April 1, 2014

Providers who currently submit paper claims to Medicare must begin using CMS-1500 form 02/12 for paper claim submissions received on or after April 1, 2014. On June 10, 2013, the White House OMB approved the revised CMS-1500 claim form, version 02/12, OMB control number, 0938-1197. The CMS-1500 claim form is the required format for submitting claims to Medicare on paper. If providers submit paper claims via the CMS-1500 08/05 version on or after April 1, 2014 to their Medicare Administrative Contractor, the claim(s) will be rejected and returned as unprocessable. Providers will be instructed to resubmit a claim(s) using the

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03/31/14

Important Update About Therapy Cap & ICD-10 Implementation

Gold Members, please log in to read about breaking new information concerning the 2014 therapy cap exception process, payment update for services reimbursed under the Medicare Physician Fee Schedule and breaking news about ICD-10 implementation. Not yet a Gold Member? Join HERE and get access to all the information on the website, monthly electronic member only newsletters, and member only breaking news email updates. On March 31, the United States Senate passed

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03/31/14

SNF ABN Requirements Clarified

The Centers for Medicare and Medicaid Services have issued clarification instructions on the use of the skilled nursing facility (SNF) Advance Beneficiary Notice (ABN) of Non-Coverage form pursuant to the Jimmo vs Sebelius settlement. The instructions cover common denial reasons why the extended care items or services are noncovered under Medicare. The SNF may use these denial paragraphs as inserts in the “Because” and “Items or Services” sections of the SNF ABN. Denial paragraphs provided by CMS include, but are not limited to, teaching and training activities – partial denial, teaching and training activities – no skilled services, teaching or

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03/11/14

First Coast to Audit Therapy Claims in Puerto Rico

On July 24, 2012, First Coast Service Options activated a prepayment edit for therapy services rendered by specialty 25 (Physical Medicine and Rehabilitation) in Puerto Rico. This was due to medical review findings that revealed this specialty presents an 88 percent error rate. The purpose of the edit is to prevent the payment of non-covered, incorrectly coded, and inappropriately billed services. Also, with medical review assistance, customer service now advises providers in correcting the billing and documentation errors. Data for October 1 through December 31, 2013, show an error rate of 81 percent. A significant amount of this error rate

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03/10/14

Therapy Cap Exception Process

If Congress does not pass additional legislation either eliminating the therapy cap or extending the exception process prior to April 1, 2014, Medicare beneficiaries will not have coverage for outpatient therapy services once they exceed $1920 PT and SLP combined or a separate $1920 for occupational therapy. If no legislation is passed and no exception process is in place, therapy provided above the $1920 would be considered

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03/10/14

WPS to Host Several Teleconferences

Wisconsin Physician Services (WPS) will be hosting several teleconferences in the month of April. The first will occur on April 9, 2014 and will focus on the Advance Beneficiary Notice of Noncoverage. WPS will also be doing a 2-part teleconference titled “Outpatient Therapy Guidelines” with Part 1 occurring on April 22, 2014 and Part 2 on April 24, 2014.

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