On September 5, 2013, the Centers for Medicare and Medicaid Services (CMS) issued a five-page document clarifying the types of practitioners who may furnish orders for inpatient services and the types of information that must be included in those orders. In the document, the CMS discusses the physician certification and practitioner orders.

Wisconsin Physician Services (WPS), Medicare Administrative Contractor for the states of Indiana, Iowa, Kansas, Michigan, Missouri, and Indiana, has add 12 new outpatient therapy FAQs to their website for practices in the above mentioned states. Topics include billing and coding, documentation, functional reporting, modifiers, and general FAQs. To access the FAQs, click

The Centers for Medicare & Medicaid Services (CMS) will make available free provider-specific comparative data reports for skilled nursing facilities (SNFs) nationwide. The Program for Evaluating Payment Patterns Electronic Report (PEPPER) provides SNF-specific data statistics for Medicare services that may be at risk for improper Medicare payments. SNFs can use the data to support internal auditing and monitoring activities. PEPPER is a free report comparing a SNF’s Medicare billing practices with other SNFs in the state, Medicare Administrative Contractor (MAC) or Fiscal Intermediary (FI) jurisdiction and nation.

Lawmakers in Washington DC are working hard this year to repeal the sustainable growth rate (SGR) formula used to determine payment under the Medicare Physician Fee Schedule (MPFS), that does include outpatient therapy services. A major stumbling block in the repeal is the additional cost to the Medicare program that would occur due to the repeal. Due to the Statutory Pay-As-You-Go Act, Congress must ensure that most new spending is offset by spending cuts or added revenue elsewhere. H.R. 2810, the Medicare Patient Access and Quality Improvement Act, adds several new items of spending without offering ways to pay for

In their September 2013 issue of OfficeLink Updates Newsletter, Aetna provides clarification on how often re-evaluations are eligible for payment for outpatient physical therapy, occupational therapy, and speech-language pathology services. Physical and occupational therapy re-evaluations (97002 and 97004) are eligible for payment

Performant Recovery, Recovery Auditor for Region A that encompasses Connecticut, Delaware, District of Columbia, Maryland, New Jersey, New York, and Pennsylvania, has announced they will conduct automated reviews on Medicare beneficiaries who are simultaneously receiving home health services reimbursed under a home health agency plan of care and outpatient therapy services provided by a hospital outpatient department or a private practice. The audit will impact hospital outpatient departments in Connecticut, Delaware, District of Columbia, Maryland, New Jersey, New York, and Pennsylvania as well as private practices in Connecticut and New York. Issues for Part B providers that are approved for

At its August 1, 2013 meeting in Chicago, The National Uniform Claim Committee (NUCC) approved a transition timeline for the version 02/12 1500 Health Insurance Claim Form (1500 Claim Form).  In June, the NUCC announced the approval of the updated 1500 Claim Form that accommodates reporting needs for ICD-10 and aligns with requirements in the Accredited Standards Committee X12 (ASC X12) Health Care Claim: Professional (837P) Version 5010 Technical Report Type 3. The transition timeline for the revised 1500-claim form is as follows:

Wisconsin Physician Services (WPS), Medicare Administrative Contractor for the states of Indiana, Illinois, Kansas, Michigan, Missouri, and Nebraska, will be hosting a webinar on October 22, 2013 from 12:00pm – 1:00PM ET (11:00am – 12:00pm CT) on the Advance Beneficiary Notice of Noncoverage (ABN). Topics will include information on when the ABN is required, completing the ABN, and much more. To sign up for the webinar, click HERE and sign in or create a new user account if new. This is the site WPS is using for registration and is not affiliated with Gawenda Seminars & Consulting, Inc.