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05/22/23

CMS to Begin Reviews on Inpatient Rehabilitation Facility Claims

The Centers for Medicare and Medicaid Services (CMS) is initiating the Review Choice Demonstration (RCD) program for Inpatient Rehabilitation Facilities (IRFs). In this article, I will provide answers to the following questions:

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05/17/23

CMS to Cover Seat Elevation Systems as an Accessory to Power Wheelchairs

On May 16, 2023, the Centers for Medicare and Medicaid (CMS) issued a decision memo announcing that CMS finds that power seat elevation equipment on Medicare-covered power wheelchairs (PWCs) falls within the benefit category for durable medical equipment (DME). In the decision summary, CMS states that power seat elevation equipment is reasonable and necessary for individuals using complex rehabilitative power-driven wheelchairs when the following conditions are met:

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05/10/23

Will Commercial Insurance Carriers Reimburse for Telehealth After the PHE Ends?

On May 4, 2023, I published an article “Will CMS Pay for Telehealth After May 11, 2023?“. I have now been receiving questions asking if commercial insurance carriers and Medicare Advantage plans will reimburse for outpatient physical, occupational and speech therapy services delivered via telehealth after the public health emergency (PHE) ends at the end of the day on May 11, 2023. In this article, I will answer that question plus provide links to Cigna, UnitedHealthcare and Humana’s telehealth policies. The answer is

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05/04/23

Will CMS Pay for Telehealth After May 11, 2023

Article updated on May 19, 2023! Disclaimer: This article is current as of May 19, 2023 and if CMS and/or Congress makes any changes, an updated article will be published. The public health emergency (PHE) ended at the end of the day on May 11, 2023. What providers of outpatient therapy services want to know is will the Centers for Medicare and Medicaid Services (CMS) reimburse for outpatient therapy services delivered via telehealth after May 11, 2023. In this article, I will provide answers to the following questions:

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05/01/23

UHC Medicare Advantage June 2023 Reimbursement Update

UnitedHealthcare (UHC) Medicare Advantage has a new reimbursement policy that could have an impact on outpatient therapy claims billed on a 1500-claim form as well as the UB-04 claim form. In this article, I will provide the answers to the following questions:

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04/28/23

Institutional Outpatient Therapy Claims Being Denied

Institutional outpatient therapy providers are experiencing claims being denied by their Medicare Administrative Contractor (MAC) beginning on and after April 1, 2023 for claims received by the MAC. In this article, I will answer the following questions:

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04/25/23

Remote Therapeutic Monitoring: CPT Codes 98980-98981

Last week, I published an article titled “Remote Therapeutic Monitoring: CPT Codes 98976-98978“. The previous week, I published an article titled “Remote Therapeutic Monitoring: CPT Code 98975 FAQs“. In this week’s article, I will answer the following questions I have been receiving about CPT codes 98980 – 98981:

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04/24/23

Remote Therapeutic Monitoring: CPT Codes 98976-98978

Last week, I published an article titled “Remote Therapeutic Monitoring: CPT Code 98975 FAQs“. In this week’s article, I will answer the following questions I have been receiving about CPT codes 98976 – 98978:

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