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04/16/18

Strapping and Taping Not Covered by Cigna for All Body Parts

Cigna has a medical coverage policy on strapping and taping that has implications for suppliers and providers of outpatient physical and occupational therapy services.In this medical coverage policy, Cigna defines when strapping is and is not medically necessary. Cigna considers strapping medically necessary for the management of immobilization of a joint and restriction of movement with strapping tape (i.e., rigid, non-elastic or non-stretchy therapeutic tape) for the following indications:

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04/12/18

Noridian to Host SNF/Swing Bed Billing Requirements Webinar

Noridian Healthcare Solutions will host a webinar on April 17, 2018 at 2:30 p.m. Central Time. This session includes: Billing Requirements Claim Adjustments Leave of Absence (LOA) Medicare Advantage (MA) residents Medical Review and CERT Common Errors To sign up for the webinar, click HERE.

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04/09/18

Medicare Advantage: How is it Different from Traditional Medicare

As more Medicare beneficiaries choose to switch their medical coverage from traditional Medicare to Medicare Advantage plans (31% in 2015), I receive more and more questions regarding do the outpatient therapy rules and regulations that apply to traditional Medicare also apply to the Medicare Advantage plans. In this article, I will answer the following questions: Do Medicare Advantage plans have an annual therapy cap? Do Medicare Advantage plans provide the same coverage as traditional Medicare? Must Medicare Advantage plans follow National Coverage Decision and Local Coverage Decision policies? If a service in not covered by the Medicare Advantage plan, must

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04/09/18

Using the ABN for Medicare Advantage Plans

The Advance Beneficiary Notice of Non-Coverage (ABN) is used when normally the service(s) or item(s) would be covered by the Medicare program, but under the circumstance, a provider does not think their Medicare Administrative Contractor will pay for a service(s) or item(s). A question I have been receiving lately is can a provider of outpatient therapy services use an ABN for Medicare Advantage (MA) plans to indicate to the MA plan that they (the provider) believe the MA will not pay for a service(s) or item(s)? The ABN is to be used

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04/09/18

CMS Releases NCCI Edits Version 24.1

The Centers for Medicare and Medicaid Services has released the National Correct Coding Initiative (NCCI) Edits Version 24.1. NCCI Edits Version 24.1 is applicable for dates of service April 1, 2018 – June 30, 2018. There are 2 versions of NCCI Edits Version 24.1; one version is for private practice and the second version is for all other outpatient therapy settings that would include rehabilitation agencies, skilled nursing facilities, home health agencies, comprehensive outpatient rehabilitation facilities and hospital outpatient departments. There are 15 new edits in both Versions of 24.1. To access NCCI Edits Version 24.1, click HERE and then

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04/02/18

Home Health Services and Outpatient Therapy Simultaneously

A question I often receive is does the Medicare program pay for a Medicare beneficiary to receive outpatient therapy services while they are simultaneously receiving home health services under an open home health agency (HHA) plan of care? In this article, I will answer this question plus provide resources for the outpatient therapy provider to determine if the Medicare beneficiary is receiving home health services. The answer is

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03/29/18

OIG Releases Report on Physical Therapy Billing

The Office of the Inspector General (OIG) has issued a report regarding the findings of a review they conducted on outpatient physical therapy services provided to Medicare beneficiaries between July 1 – December 31, 2013. For calendar year (CY) 2013, the Medicare Part B program paid approximately $1.8 billion for outpatient physical therapy services provided to beneficiaries. The OIG sampling frame consisted of 9,037,556 outpatient physical therapy service claims with a place of service code of 11 (signifying that the therapist provided the service in an office setting), totaling $635,771,872, of which we reviewed a stratified random sample of 300

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03/26/18

Manual Therapy vs Massage: What’s the Difference?

I often receive the following questions regarding massage and manual therapy: What is the description of massage and manual therapy? Does the Medicare program pay for massage and manual therapy? What is the difference between massage and manual therapy? What is the difference in payment between massage and manual therapy? Do private insurance carriers pay for massage (CPT Code 97124) In this article, I will answer the above 5 questions. According to the American Medical Association (AMA), CPT 2018 Professional Edition, the descriptions for massage and manual therapy are as follows:

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