I often receive questions when a Medicare beneficiary exceeds the therapy cap that go something like this: Currently, I have a patient that has gone over the $2010 or $3000 amount for Medicare. She has not progressed and responded to therapy interventions. She insists that her secondary will pick up the full amount if Medicare denies. I’ve used the GA modifier basically telling Medicare the therapy services are not necessary and had the patient sign an advance beneficiary notice of noncoverage (ABN) form. Will the secondary pay if the Medicare program denies? Does it matter if the secondary insurance is

Palmetto GBA provided a webinar on April 24, 2018 on skilled nursing facility (SNF) consolidated billing. The material presented in the webinar was current as of April 1, 2018. Any changes or new information superseding this webcast is provided in articles with publication dates after 4/1/2018 on the Palmetto GBA website. The agenda for the webinar included: SNF Coverage SNF Consolidated Billing (CB) MDS Resource Utilization Groups (RUGs) Documentation Medical Review Common Errors To access the handout, log into your account or become a Gold Member and click  

On December 12, 2017, President Trump signed the National Defense Authorization Act (NDAA) into law. One important piece of legislation included in the NDAA directs the Department of Defense (DOD) to add physical therapist assistants (PTAs) and occupational therapy assistants (OTAs) to the TRICARE program as an eligible provider of therapy services. Even though the NDAA is now law, the DOD must now make the change to add PTAs and OTAs as eligible providers of therapy services. The DOD must also establish, in regulations, requirements for the supervision of PTAs and OTAs. Until this is completed, PTAs and OTAs are

The Centers for Medicare and Medicaid Services (CMS) has published a 5-minute video that explains the Targeted Probe and Educate (TPE) program in more detail. To view the TPE video, click HERE. To read a more detailed article I wrote on the TPE program, click HERE.

Therapists and assistants often spend time with patients, a parent of a patient, or a patient’s caregiver such as a spouse, son, daughter or a hired caregiver teaching them exercises to do at home as part of a home exercise program. In addition, therapists and assistants spend time training a patient’s caregiver (i.e. parent, spouse, son, daughter) how to assist the patient with various activities outside of the clinic setting such as gait on level services, ascending/descending steps with an assistive device, dressing, bathing, bed mobility, transfers, feeding and using a speech generating communication device. Two questions I receive concerning

Palmetto GBA has posted an online module that provides an overview of Change of Therapy (COT) in the Skilled Nursing Facility (SNF) setting. The following topics are introduced in this course: coverage, regulations, Resource Utilization Group (RUG), SNF Prospective Payment System (PPS), assessments, and tips. To access the module, click HERE.

First Coast Service Options will be hosting a webcast on May 29, 2018 exclusively for Inpatient Rehabilitation Facilities (IRFs) to educate them on the admission documentation requirements necessary for a stay to be considered reasonable and necessary by reviewing the preadmission screening, post-admission physician evaluation, overall plan of care, and admission order. For additional information and to register, click HERE.

Wisconsin Physician Services (WPS) has several upcoming in-person seminars or webinars applicable to physical, occupational and speech therapy services. Topics include the following: Effective Medicare Documentation for Outpatient Rehabilitation Therapy Services SNF Consolidated Billing – A Collaborative Effort Between WPS and CGS Home Health Billing and Documentation Requirements For the complete list and to register, click HERE.