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

From the Centers for Medicare and Medicaid Services: The Budget Control Act of 2011 requires, among other things, mandatory across-the-board reductions in Federal spending, also known as sequestration. The American Taxpayer Relief Act of 2012 postponed sequestration for 2 months. As required by law, President Obama issued a sequestration order on March 1, 2013. The Administration continues to urge Congress to take prompt action to address the current budget uncertainty and the economic hardships imposed by sequestration. This message is directed at the Medicare FFS program (i.e., Part A and Part B). In general, Medicare FFS claims with dates-of-service or

On April 1, 2013, the multiple procedure payment reduction will increase to 50% in all outpatient therapy settings who are reimbursed under the Medicare Physician Fee Schedule. The first unit of the CPT code that has the highest practice expense (PE) value will retain 100% of its value. Subsequent units of that CPT and all other CPT codes billed that day will have their PE value decreased by 50%. This will cause an approximate 6-9% reduction in your payments.

Effective February 27, 2013 all PT and PTA licensees will be required to obtain continuing competency in order to renew their license. The Committee will require all licensees to have completed

Without Congressional intervention by March 1, 2013, sequestration will have across the board budget cuts to every department in the federal government and will have impact on outpatient therapy services. Per the American Physical Therapy Association, sequestration will decrease Medicare payment for outpatient therapy services by

Cigna, Medicare Administrative Contractor for the states of Ohio and Kentucky, has released a Medical Review FAQ. Even though this is for providers in Ohio and Kentucky who have Cigna as their Medicare contractor, providers in other states may find the FAQ’s helpful. To access the FAQ’s click

Wisconsin Physician Services (WPS), Medicare Part A contractor for the states of Iowa, Kansas, Missouri, and Nebraska, has a new address to submit appeal requests to. This is for non-private practice settings in the above mentioned states. Send all 1st level redetermination appeals to:

On February 21, 2013, the Centers for Medicare and Medicaid Services (CMS) clarified the manual medical review process for 2013 and the application of the therapy cap as it applies to critical access hospitals. In 2013, Medicare Administrative Contractors (MACs) will conduct