The Office of the Inspector General (OIG) has released their 2014 work plan and to no one’s surprise, therapy is in the work plan.The OIG will focus on critical access hospitals (CAH’s) and the Medicare beneficiaries cost for outpatient therapy services as well as the cost the Medicare program reimburses for swing beds in a CAH compared to the same service provided in a skilled nursing facility. The OIG will look at inpatient rehabilitation facilities (IRF) and adverse events that occur to Medicare beneficiaries in the IRF setting and determine the extra cost to the Medicare program due to the

The Centers for Medicare and Medicaid Services has revised the Inpatient Rehabilitation Facility Prospective Payment Fact Sheet. To access the revised fact sheet, click HERE.

Wisconsin Physician Services, Medicare Administrative Contractor for the states of Indiana and Michigan, will be hosting a webinar on February 3, 2014 on the Medicare Appeals Process. To learn more and to register for the webinar, click HERE.

The Centers for Medicare and Medicaid Services has released an article intended for physicians who refer patients to home health, order home health services, and/or certify patients’ eligibility for the Medicare home health benefit, home health agencies, and non-physician practitioners (NPPs). Effective January 1, 2011, the Affordable Care Act mandates that prior to certifying a beneficiary’s eligibility for the HH benefit, the certifying physician must document that he or she or an allowed non-physician practitioner (NPP) had a face-to-face encounter with the beneficiary. This article provides the narrative requirements of what a physician or NPP must document in the medical

The Centers for Medicare and Medicaid Services have released instructions regarding the implementation of the therapy cap to critical access hospitals. This will also include the exceptions process and the manual medical review of claims in excess of the therapy threshold when required by statute. Click

The Centers for Medicare and Medicaid Services have released the 2014 therapy code list. This release updates the list of codes that sometimes or always describe therapy services, that when provided by a therapist or therapist/therapy assistant under the supervision of a therapist, will count towards the Medicare beneficiaries annual therapy cap dollar threshold. The 2014 changes are as follows:  

The Centers for Medicare and Medicaid Services has released revised instructions regarding the 1500 claim form to reflect the revised 1500 claim form, version 02/12. The revised form, 02/12, will replace the current Form CMS-1500, 08/05, effective with claims received on and after

The CMS-1500 Claim Form has been revised to support the ICD-10 diagnosis codes. Medicare will begin accepting the revised forms on January 6, 2014. Starting April 1, 2014, Medicare will accept only the revised version of the form. Only providers who qualify for exemptions from electronic submission may submit the CMS-1500 claim form. Additional information is posted to the September 12, 2013 MLN Connects Provider e-news.