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06/03/24

Outpatient Therapy In an Assisted Living Facility

I receive many questions regarding treating Medicare beneficiaries for outpatient physical, occupational and/or speech therapy who reside in an assisted living facility (ALF). In this article, I will answer the following questions:

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05/27/24

Medicare’s 8-Minute Rule: Who Does it Apply To?

The Centers for Medicare and Medicaid Services (CMS) implemented what has become known as the “8-minute rule” on April 1, 2000. We all know this rule applies to traditional Medicare and outpatient therapy, but what about Medicare Advantage, federal insurance carriers, Medicaid, and commercial insurance carriers? In this article, I will answer the following questions:

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05/20/24

Understanding Railroad Medicare Billing

Many therapists, private practices, and facilities do not understand the difference between traditional Medicare and Railroad Medicare and what they must do in order to be reimbursed for outpatient physical, occupational, and speech therapy services. In this article, I will answer the following questions regarding Railroad Medicare Billing:

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05/13/24

MIPS Promoting Interoperability Hardship Exception

Beginning with the 2024 Merit-Based Incentive Payment System (MIPS) Performance Period, physical therapists, occupational therapists, and speech-language pathologists that participate in the MIPS program are no longer automatically exempted from the promoting interoperability category. If you feel that you are unable to report the promoting interoperability category, you may submit a MIPS Promoting Interoperability Category Hardship Exception Application citing one of the reasons below: Since MIPS eligible clinicians must submit collected data for the required measures in each objective for the same 180 continuous days (or more) during the calendar year, you will want to submit your exception application as

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05/13/24

Medicare Progress Reports

I receive many questions regarding traditional Medicare and progress report rules, regulations, and requirements. In this article, I will answer the following questions regarding progress reports for traditional Medicare:

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05/06/24

UnitedHealthcare Introduces a Diagnosis Code Requirement Policy

UnitedHealthcare (UHC)has introduced a comprehensive diagnosis code requirement policy for both professional and facility services. This new policy will combine 3 existing diagnosis policies into this new comprehensive diagnosis policy. The effective date of the new policy is To access this new policy as it applies to UHC Medicare Advantage, click To access this new policy as it applies to UHC Community Plans, click To access this new policy as it applies to UHC Individual Exchange Plans, click

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04/29/24

Federal Trade Commission Bans Noncompetes

On April 23, 2024, the Federal Trade Commission (FTC) issued a final rule banning noncompetes nationwide. This ban will allow workers to freely change jobs.

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04/22/24

Can a Medicare Beneficiary Receive Outpatient Therapy at More Than One Practice/Organization During the Same Time Period?

There may be circumstances where a Medicare beneficiary may be receiving therapy services at more than 1 practice/organization during the same time period, either by the same discipline or different disciplines. However, when this occurs, will the Medicare program reimburse both practices/organizations of outpatient therapy services? The answer is

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