Cigna Government Services, Medicare Administrative Contractor in Ohio and Kentucky, has announced a new probe medical review on inpatient hospital claims for appropriateness of inpatient admission under the revised two-midnight benchmark for dates of admission October 1, 2013 through December 31, 2013. For additional information on this review, click HERE.

Novitas, Medicare Administrative Contractor for Jurisdiction H that includes the states of Arkansas, Colorado, Louisiana, Mississippi, New Mexico, Oklahoma, and Texas, has updated their therapy FAQs on topics of appeals, billing of outpatient therapy services, outpatient rehabilitation documentation and additional development requests, and SNF billing and rehabilitation. To access the FAQ’s, click

On November 27, 2013, the Centers for Medicare and Medicaid Services (CMS) released the final rule for services reimbursed under the Medicare Physician Fee Schedule (MPFS). The final rule contains information on the 2014 conversion factor used to determine payment, 2014 therapy cap, therapy cap exception process, manual medical review process, application of the therapy cap to critical access hospitals, application of the therapy cap to hospital outpatient departments, significant changes to the PQRS program for private practices, and incident-to-physician services, just to name a few. Therapy Cap, Exception Process & Review for Claims Exceeding $3700 The therapy cap dollar

There are two levels in the Medicare Appeals process (Level III and Level V) that requires an amount in controversy (AIC) in order for the request to be considered. Following the Qualified Independent Contractor’s (QIC’s) decision, a party to the reconsideration may request an Administrative Law Judge (ALJ) hearing within 60 days of receipt of the reconsideration decision. Appellants must send notice of the ALJ hearing request to all parties to the QIC for reconsideration. In order to request a hearing by an ALJ, the amount remaining in controversy must meet the threshold requirement. For calendar year 2014, the amount

The Centers for Medicare and Medicaid Services (CMS) has released the 2014 deductible, coinsurance and premium rates. CMS announced that premiums for Medicare Part B will remain flat in 2014 and the Medicare Part B deductible will remain $147.00 as it was in 2013. Premiums for Medicare Part B will remain at $104.90, the same as it was in 2013. The Medicare Part A premium will decrease $15.00 in 2014 to $426.00. Part A pays for inpatient hospital care, skilled nursing facilities and some home care services; however, 99% of Medicare users do not pay premiums for Part A. The

Noridian, Medicare Administrative Contractor for Jurisdiction E, has retired their Outpatient Occupational Therapy L33330, Outpatient Physical Therapy L33331 and the Outpatient Speech Language Pathology L33744 Local Coverage Determinations (LCDs) effective November 06, 2013. To read more about this, click HERE for private practices and click HERE for non-private practices.

Noridian will be holding a series of workshops in December and January for SNF/Swing Bed PPS providers and those impacted by SNF Consolidated Billing. To check dates and times, click HERE.

The local coverage determination (LCD) for therapy and rehabilitation services was most recently revised January 1, 2013. Since that time, the LCD was revised to add Current Procedural Terminology (CPT®) codes 96125 and 97532 specific to speech-language therapy services under the “CPT®/HCPCS Codes” section of the LCD. CPT® code 96125 was also added specific to physical and/or occupational therapy services under the “CPT®/HCPCS Codes” section of the LCD. In addition, the “Sources of Information and Basis for Decision” section of the LCD was also revised.