The Centers for Medicare and Medicaid Services (CMS) has issued instructions for Medicare Administrative Contractors (MACs) to provide notification of the reopening process and to notify the provider or supplier of their intent to reopen a specific claim when requested documentation is received after a denial of the claim has been made. If the MACs receive the requested information from a provider or supplier after a denial has been issued but within a reasonable number of days (generally 15 calendar days after the denial date), they have the discretion to reopen the claim. MACs who choose to reopen a specific

Whether an insurance carrier will pay for therapy services provided in the patient’s home under their outpatient therapy benefits is the answer most people do not like; it is insurance carrier specific. Regarding the Medicare program, the Centers for Medicare and Medicaid Services (CMS) states therapy services are payable under the Medicare Physician Fee Schedule when furnished by a provider or supplier in the following settings:

Last week, I published “Who Writes Progress Reports Under Medicare Part B” and as you can imagine, had lots of follow up questions and comments. Some of the questions received were: 1. Can a physical therapist assistant (PTA) or occupational therapy assistant (OTA) see the Medicare patient the same day the physical therapist (PT) or occupational therapist (OT) also sees the patient and will write the progress report? 2. Can a PTA or OTA see the Medicare beneficiary for a follow-up therapy visit, collect the subjective information and objective data and include that information in their daily note? 3. Can

I am often asked what CPT code to bill for an ice massage. According to the American Medical Association, the correct CPT code to bill for ice massage is CPT code

I am often asked if physical therapist assistants (PTAs) or occupational therapy assistants (OTAs) can write the progress report that is required by the Centers for Medicare and Medicaid Services (CMS) at least once every 10 visits for Medicare beneficiaries receiving outpatient therapy services. CMS is very clear on their answer regarding this question. According to CMS, the required progress report

Does the Centers for Medicare and Medicaid Services (CMS) require physicians to sign and date progress reports that are written by a physical therapist, occupational therapist and/or speech-language pathologist? The answer may surprise you. CMS does

On April 27, 2018, the Centers for Medicare and Medicaid Services (CMS) released the fiscal year (FY) 2019 proposed rule for inpatient rehabilitation facilities (IRFs). This proposed rule would update the prospective payment rates for inpatient rehabilitation facilities (IRFs) for FY 2019. As required by the Social Security Act (the Act), this proposed rule includes the classification and weighting factors for the IRF prospective payment system’s (PPS) case-mix groups and a description of the methodologies and data used in computing the prospective payment rates for FY 2019. CMS is also proposing to alleviate administrative burden for IRFs by removing the

On April 27, 2018, the Centers for Medicare and Medicaid Services (CMS) released the fiscal year (FY) 2019 proposed rule for Part A skilled nursing facility (SNF) services. This proposed rule would update the payment rates used under the prospective payment system (PPS) for skilled nursing facilities (SNFs) for FY 2019. This proposed rule also proposes to replace the existing case-mix classification methodology, the Resource Utilization Groups, Version IV (RUG-IV) model, with a revised case-mix methodology called the Patient-Driven Payment Model (PDPM) effective October 1, 2019. It also proposes revisions to the regulation text that describes a beneficiary’s SNF “resident”