Palmetto GBA will be providing an informative Part A Skilled Nursing Facility (SNF) Consolidated Billing webcast on April 25, 2018 at 10 am ET!  This webcast is designed to provide an overview of SNF Coverage, SNF Consolidated Billing (CB), MDS Resource Utilization Groups (RUGs), claim submission, and documentation. To register for the 1 hour webcast, click HERE.

Effective May 25, 2017, the Centers for Medicare & Medicaid Services (CMS) issued a National Coverage Determination (NCD) to cover Supervised Exercise Therapy (SET) for beneficiaries with Intermittent Claudication (IC) for the treatment of symptomatic Peripheral Artery Disease (PAD). SET involves the use of intermittent walking exercise, which alternates periods of walking to moderate-to-maximum claudication, with rest. SET has been recommended as the initial treatment for patients suffering from IC, the most common symptom experienced by people with PAD. CMS issued the NCD to cover SET for beneficiaries with IC for the treatment of symptomatic PAD. Up to 36 sessions

Palmetto GBA, the Medicare Administrative Contractor for the states of Alabama, Georgia, North Carolina, South Carolina, Tennessee, Virginia and West Virginia, has updated their physical therapy, occupational therapy and speech therapy local coverage determinations (LCDs) for nonprivate practices in the above mentioned states. To access the revised LCDs, click HERE.

Since passage of the 2018 Bipartisan Budget Act of 2018 that repealed the therapy cap for outpatient therapy services, I have been receiving many questions about the application of the KX modifier for services that exceed either $2010 or $3000 physical therapy and speech therapy combined in 2018 or a separate $2010 or $3000 for occupational therapy. Most of the questions center around should I provide the Medicare beneficiary with an advance beneficiary notice of noncoverage (ABN)  when they exceed either $2010 or $3000 in calendar year 2018? In this article, I will answer the following questions: If the therapy

I receive many questions at my in-person seminars and via email that begin something like “I know we can’t have 2 Medicare patient’s 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 patient’s 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

Humana has announced 8 payment changes effective March 1, 2018 that will impact providers of outpatient physical, occupational and speech therapy services. While Humana states the effective date is March 1, 2018, it appears that the changes may have already been implemented with dates of service on and after January 1, 2018. Effective with dates of service on and after March 1, 2018, Humana will no longer pay for the following CPT codes:

The Centers for Medicare and Medicaid Services (CMS) has issued clarifying instructions for conducting medical review of Inpatient Rehabilitation Facility (IRF) claims when reviewing the requirements for the intensive level of rehabilitation therapy services. The instructions state the Medicare Administrative Contractors, Supplemental Medical Review Contractor, Recovery Audit Contractors and the Comprehensive Error Rate Testing contractor shall not make absolute claim denials based solely on a threshold of therapy time not being met. When the current industry standard of generally 3 hours of therapy (physical therapy, occupational therapy, speech-language pathology, or prosthetics/orthotics) per day at least 5 days per week or

The Centers for Medicare and Medicaid Services released MedLearn (MLN) Matters 10176 on December 21, 2017 and is related to Change Request (CR) 10176. CR 10176 implements revised editing of Part B “Always Therapy” services to require the appropriate therapy modifier in order for the service to be accurately applied to the therapy cap. CR 10176 contains no new policy. Instead, the guidelines presented in the CR improve the enforcement of longstanding, existing instructions. Make sure your billing staffs are aware of these revisions. To access MLN 10176, click HERE.