The Centers for Medicare & Medicaid Services (CMS) released transmittal 1196 on March 8, 2013 with an effective an implementation date of April 1, 2013 regarding outpatient therapy functional reporting non-compliance alerts. For therapy claims, with dates of service on and after January 1, 2013, processed on and after April 1, 2013 through June 30, 2013, contractors shall alert providers to

From UnitedHealthcare March 2013 Network Bulletin CMS issued National Coverage Determination (NCD) 160.27 Transcutaneous Electrical Nerve Stimulation (TENS) for Chronic Low Back Pain (CLBP) effective June 8, 2012, limiting coverage of TENS for CLBP to members who are enrolled in a CMS approved clinical trial and meet certain criteria. When coverage requirements are met original Medicare will be responsible for payment of TENS for CLBP under the clinical trial, NCD 310.1 Routine Costs in Clinical Trials. Otherwise, TENS for CLBP is not covered and UnitedHealthcare Medicare Advantage Plans will no longer be responsible for payment. This applies to all members

For dates of service January 1, 2013 through December 31, 2013, all outpatient therapy claims submitted above the $3,700 threshold will be subject to prepayment medical review. CGS will send Additional Documentation Requests (ADRs) for all claims above the $3,700 threshold. In these ADRs, CGS will request the following documentation:

Palmetto GBA, Medicare contractor for California, Hawaii, and Nevada, will host a webinar on March 27, 2013 from 11:30AM-1:00PM PT. Skilled Nursing Facility services on both ends of the RUG-IV spectrum can be difficult to document and valuable information is often missing.  In this course designed for billers, nurses, MDS Coordinators, and physicians, we will explore documentation requirements for the Lower 14 RUGs as well as the highest RUGs, which fall into the Rehab Ultra High classification. To register, click HERE.

In a rule released today, the Centers for Medicare & Medicaid Services proposes to revise its position on rebilling for claims denied by Medicare contractors, including recovery audit contractors. Based on a preliminary review of the regulations, it appears that hospitals will generally be eligible for Part B payment following

The Centers for Medicare & Medicaid Services updated the therapy question and answers on February 28, 2013. You’ll find clarifications on reassessments in the revised Q&As. To access the updated Q&As, click

The Centers for Medicare & Medicaid Services recently posted checklists and timelines to help small hospitals, physician practices and payers transition to ICD-10 for reporting patient diagnoses and inpatient procedures. Under a final rule issued in August, hospitals and other entities covered by the Health Insurance Portability and Accountability Act must transition to the ICD-10 coding system by Oct. 1, 2014. Watch for an ICD-10 webinar for therapy services from Gawenda Seminars & Consulting this fall. To access the timelines and checklists, click

The Centers for Medicare and Medicaid Services (CMS) has issued a special edition MLN Matters® article that is a consolidation and update of prior articles (SE1011, SE1201, SE1208, and SE1221) regarding ordering and referring services. Effective May 1, 2013, the CMS will turn on the phase 2 denial edits. This means that Medicare will deny claims for services