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07/12/22

CMS Estimate Payment for Outpatient Therapy in 2023

On July 7, 2022, the Centers for Medicare and Medicaid Services (CMS) released the calendar year (CY) 2023 proposed rule for services reimbursed under the Medicare Physician Fee Schedule (MPFS). Click HERE to read my summary on the proposals that will impact outpatient physical, occupational and speech therapy services. Comments are due by 5:00pm on September 6, 2022. In this article, I will provide my members with the estimated payment for calendar year 2023 for the more common CPT codes billed in outpatient therapy compared to the 2022 payment rate for each CPT code. For my examples, I used Detroit,

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07/11/22

CMS Release CY 2023 Proposed Rule for Services Reimbursed Under the MPFS

On July 7, 2022, the Centers for Medicare and Medicaid Services (CMS) released the calendar year (CY) 2023 proposed rule for services reimbursed under the Medicare Physician Fee Schedule (MPFS). Comments are due by 5:00pm on September 6, 2022. In this article, I will provide a summary regarding the following CMS proposals for CY 2023:

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07/04/22

UnitedHealthcare July 2022 Medical Policy Updates

UnitedHealthcare (UHC) Commercial has issued a revised medical policy for UHC Community plan has issued a revised medical policy for

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06/20/22

Does Sequestration Reduction Apply to Medicare Advantage Plans

Due to COVID-19, the 2% sequestration reduction for traditional Medicare was placed on pause until April 1, 2022. Beginning with dates of service between April 1 – June 30, 2022, the sequestration reduction returned at 1% and then increases to 2% for dates of service on and after July 1, 2022. What therapy providers want to know is does the sequestration reduction also automatically apply to Medicare Advantage plans? The answer is

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06/15/22

Highmark Implements CQ/CO Modifier Payment Reduction

Highmark BCBS has implemented the CQ/CO therapist/therapy assistant modifier reduction. The reduction applies to the following states, Highmark plan(s) and claim forms:

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06/15/22

Highmark Requires Prior Authorization for Speech Therapy

Highmark BCBS has put out a reminder that the CPT codes listed below now require prior authorization for speech therapy since March 15, 2022. The codes are as follows:

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06/13/22

Making Amendments, Corrections and Addenda’s in Medical Records

Whether you document in an electronic medical record (EMR), on paper, or dictate your notes, most likely, you have made an error in your documentation and/or omitted documentation in the medical record for that treatment visit. When this occurs, the Centers for Medicare and Medicaid Services (CMS) has provided instructions on record keeping principles, whether you document on paper or in an EMR. Per CMS, documents submitted to MACs, CERT, Recovery Auditors, SMRC and UPICs, whether paper or EMR, containing amendments, corrections or addenda must:

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06/06/22

Does TRICARE Follow Medicare’s “8-Minute Rule”?

The Centers for Medicare and Medicaid Services (CMS) implemented what providers of outpatient therapy call “Medicare’s 8-minute rule” in 2000. There is a misconception that the “8-minute rule” applies automatically to all federal insurance carriers and Medicare Advantage plans. That is actually not true. Each federal insurance carrier and Medicare Advantage plan can determine if they want to apply Medicare’s “8-minute rule” for payment for outpatient therapy services or use the American Medical Associations’ (AMA) substantial portion methodology. In this article, I will provide the answer to TRICARE and do they follow Medicare’s “8-minute rule” or the AMA substantial portion

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