The Centers for Medicare and Medicaid Services (CMS) will host a Medicare Learning Network event on Tuesday January 9, 2018 from 1:30 to 2:30pm ET to discuss a settlement option for providers and suppliers (appellants) with fewer than 500 appeals pending at the Office of Medicare Hearings and Appeals (OMHA) and the Medicare Appeals Council (the Council) at the Departmental Appeals Board. For additional information on the low volume appeals initiative, click HERE. To register, click HERE.

The Centers for Medicare and Medicaid Services (CMS) has released an article that reiterates their current policy related to claims submitted with regard to services provided to Medicare beneficiaries in an Inpatient Rehabilitation Facility (IRF). This article discusses key elements of IRF coverage criteria including required documentation elements and a post-admission physician evaluation. To view this article, click HERE.

Effective for dates of service on and after January 1, 2018, there will be 2 new modifiers that providers may be required to use with some insurance carriers, such as Affordable Care Act (ACA) compliant plans, to distinguish whether the service provided was rehabilitative in nature or habilitative in nature. The new modifiers will not replace the existing modifier for habilitative services. The 2 new modifiers are:

On September 11, 2017, I published an article titled” TRICARE Changes Coming in 2018” where I discussed the 3 current TRICARE regions will be consolidated to 2. TRICARE North and TRICARE South will combine to form TRICARE East and TRICARE West will remain essentially unchanged. In addition, each of the 2 regions will have new regional contractors that providers of therapy services will have to enroll with in order to treat TRICARE patients on and after January 1, 2018 with the exception of if your current contract is with Humana Military. The TRICARE West Region includes the states of Alaska,

On January 1, 2018, the Centers for Medicare and Medicaid Services (CMS) will no longer require the use of the GT modifier on professional claims for telehealth services. Use of the telehealth POS code 02 certifies that the service meets the telehealth requirements. Click HERE for the CMS transmittal.

On December 12, 2017, President Trump signed the National Defense Authorization Act (NDAA) into law. One important piece of legislation included in the NDAA directs the Department of Defense (DOD) to add physical therapist assistants (PTAs) and occupational therapy assistants (OTAs) to the TRICARE program as an eligible provider of therapy services. Even though the NDAA is now law, the DOD must now make the change to add PTAs and OTAs as eligible providers of therapy services. The DOD must also establish, in regulations, requirements for the supervision of PTAs and OTAs. Until this is completed, PTAs and OTAs are

The Centers for Medicare and Medicaid Services (CMS) has released the National Correct Coding Initiative (NCCI) Edits Version 24.0. Version 24.0 will be valid for dates of service beginning January 1, 2018 and ending March 31, 2018. Version 24.0 has some significant additions due to changes in CPT codes 97760 and 97761, the addition of CPT codes 97127 and 97763 and the deletion of CPT codes 29582, 29583 and 97532. In addition, there are changes to the edits for CPT codes 97750 and 97755 when billed on the same day as a physical or occupational therapy evaluation or reevaluation. Lastly,

The Centers for Medicare and Medicaid Services (CMS) has issued a final rule that makes significant changes to the Comparative Joint Replacement (CJR) model beginning on January 1, 2018. In addition, this rule finalizes the CMS proposal to cancel the Episode Payment Models (EPMs) and the Cardiac Rehabilitation (CR) Incentive Payment Model. The EPMs that have now been canceled include acute myocardial infarction, coronary artery bypass graft and surgical hip/femur fracture treatment episodes of care. Beginning January 1, 2018, the CJR model will be mandatory in 34 metropolitan statistical areas (MSAs) instead of the current 67 MSAs. For the remaining