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04/11/22

CMS Releases IRF FY 2023 Proposed Rule

On March 31, 2022, the Centers for Medicare and Medicaid Services (CMS) released the fiscal year (FY) 2023 proposed rule for Inpatient Rehabilitation Facilities. The proposed rule was published on April 6, 2022 and CMS is accepting comments on the proposed rule until 5:00pm on May 31, 2022. To access the proposed rule, click

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03/28/22

NCCI Edits Version 28.1 Effective April 1, 2022

National Correct Coding Initiative (NCCI) Edits Version 28.1 are effective with dates of service April 1, 2022 – June 30, 2022. To access Gawenda Seminars & Consulting, Inc. therapy specific NCCI edit reference sheet that will assist you in determining whether modifier 59 is required or not, click HERE.

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03/21/22

Does One-on-One Only Apply to Traditional Medicare?

I receive many questions at my in-person seminars and via email that begin something like “I know we can’t have 2 Medicare patients being treated at the same time, but how about 2 patient’s with private insurance”? Or, “I know I need to be one-on-one with Medicare patient’s, but that does not apply to patients with private insurance, right”? Lastly, “I know if I have 2 Medicare patient’s in my facility for one hour during the same time period, I have to split the time between them, but if the 2 patient’s had private insurance, I could bill each for

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03/21/22

CPT Codes That Require Direct One-on-One Contact

In this article, I will provide which CPT codes require the therapist or assistant have direct one-on-one patient contact in order to bill that CPT code to the patient for that visit. According to the American Medical Association, CPT 2022, Professional Edition, the following CPT codes require direct one-on-one patient contact for physical and occupational therapy services: I hope you found this article informative. Thank you for being a Gold Member! All material posted on our website is intellectual property of Gawenda Seminars & Consulting, Inc. and can’t be used, reproduced, or posted as your own material without prior written

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03/14/22

Telehealth Under Medicare Extended Once PHE Ends

As many of you know, outpatient physical, occupational and speech therapy delivered via telehealth for traditional Medicare beneficiaries was due to expire once the public health emergency (PHE) is declared over. Well, that has now changed due to recent legislation that was signed into law. In this article, I will answer the following questions: When will the traditional Medicare program stop paying for outpatient physical, occupational and speech therapy delivered via telehealth? Why did this change occur? At this time, when does the PHE end? Where can I access this change incase I need the reference? Let’s begin! Question #1When

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03/07/22

Medicare Improper Payments as They Apply to Outpatient Therapy Services

The Improper Payments Elimination and Recovery Improvement Act (IPERIA) of 2012 requires the heads of Federal agencies, including the Department of Health and Human Services (HHS), to annually reviewprograms it administers to improve agency efforts to reduce and recover improper payments. Each November, the Department of Health and Human Services (HHS) publishes the improper payment rate in the Agency Financial Report. The Centers for Medicare and Medicaid Services (CMS) later publishes more detailed improper payment rate information in the form of the annual Medicare Fee-for-Service (FFS) Improper Payments Report and Appendices. This list contains reports produced by the Comprehensive Error

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03/07/22

UHC Revises Negative Pressure Wound Therapy Medical Policy

UnitedHealthcare (UHC) Commercial and UHC Oxford have revised their Negative Pressure Wound Therapy medical policy with an effective date of May 1, 2022. To access the revised policy,

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02/21/22

Group Therapy Frequently Asked Questions and Answers

CPT code 97150 (Group Therapy) remains one of the most confusing CPT codes for physical therapists, physical therapist assistants, occupational therapists, and occupational therapy assistants to understand. In this article, I will answer the following questions: Let’s Begin!

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