A question I receive is can a speech-language pathologist (SLP) bill CPT code 92507 (treatment of speech, language, voice, communication, and/or auditory processing disorder, individual) or CPT code 92508 (treatment of speech, language, voice, communication, and/or auditory processing disorder, group) on the same day they also bill CPT code 97127 – therapeutic interventions that focus on cognitive function (eg, attention, memory, reasoning, executive function, problem solving and/or pragmatic functioning) and compensatory strategies to manage the performance of an activity (eg, managing time or schedules, initiating, organizing and sequencing tasks), direct (one-on-one) patient contact? To simplify the question, can an SLP

A question I receive is can a speech-language pathologist (SLP) bill CPT code 92507 (treatment of speech, language, voice, communication, and/or auditory processing disorder, individual) or CPT code 92508 (treatment of speech, language, voice, communication, and/or auditory processing disorder, group) on the same day they also bill CPT code 97533 (sensory integrative techniques to enhance sensory processing and promote adaptive responses to environmental demands)? To simplify the question, can an SLP bill 92507 and/or 92508 and 97533 on the same day for a patient who has Medicare as their insurance? The answer might surprise you! According to the 2018 National

The Centers for Medicare & Medicaid Services (CMS) has had multiple auditing entities, including the Recovery Auditors, Comprehensive Error Rate Testing (CERT) Contractors, and Medicare Administrative Contractors (MACs) review claims for total major joint replacements such as hips and knees. Their findings have demonstrated very high paid claim error rates among both hospital and professional claims associated with major joint replacement surgery. The Centers for Medicare and Medicaid Services (CMS) has published a booklet regarding hip and knee joint replacements that provides information on the following: How to document medical necessity Complete and accurate medical records Key points for billing

For those of you that provide outpatient therapy services to Medicare beneficiaries, many of you will see a decrease in your payments in 2018 compared to 2017 due to a reduction in payment of the most commonly billed CPT codes to the Medicare program. However, several CPT codes that perhaps you should have been billing all these years will see an increase in their payment rate in 2018 compared to 2017. This change in payment is due to changes in the work relative value unit (RVU) and practice expense (PE) RVU of the CPT codes. The work RVU takes into

Humana will no longer require preauthorization for outpatient physical, speech and occupational therapy services for patients with commercial and Medicare Advantage (MA) coverage, effective Dec. 18, 2017. Following are some important details about this change: While preauthorization will no longer be required, visit limits and other plan provisions (e.g., referrals) will still apply. Referrals should be submitted to Humana via Availity.com (registration required) for prompt processing. Physicians and other health care professionals may be asked to submit medical records to substantiate the medical necessity of services that have been provided. For additional information and to access the Humana Medical Coverage

Since Congress did not repeal the annual therapy cap or extend the therapy cap exception process into 2018, most outpatient therapy settings will now be dealing with a hard therapy cap of $2010.00 for physical therapy and speech-language pathology services combined and a separate $2010.00 for occupational therapy services. Why did I say most outpatient therapy settings will be dealing with a hard therapy cap in calendar year 2018? That’s because outpatient hospitals, but not critical access hospitals (CAHs), will be exempt from the 2018 annual therapy cap. Continue reading below to see why outpatient hospitals, but not CAHs, are

With the beginning of a New Year, I often receive the following questions regarding patients that were being seen for outpatient therapy in December and continue to receive therapy in January of the new year: Do I need to perform and bill for an evaluation or reevaluation on the patient’s first visit in January? Do I need an updated signed plan of care if the patient has traditional Medicare? Do I need an updated physician order for my non-Medicare patients? Must I report the functional limitation reporting G-codes on the patient’s first date of service in January? If I was

The United States Senate and House of Representatives have recessed for the Christmas Holiday without repealing the therapy cap or extending the therapy cap exception process. Congress will not return to Capital Hill until January 3, 2018. So what does this mean for Medicare beneficiaries receiving outpatient therapy services in 2018 in a non- outpatient hospital setting and in a outpatient hospital therapy setting? There will now be a hard therapy cap dollar threshold of