In last weeks article, Reevaluations vs Progress Reports: What’s the Difference?, I explained the difference between a reevaluation and a progress report, how the 2 terms are not the same and should not be used interchangeably and when a reevaluation is appropriate to perform and bill to an insurance carrier. This week, I want to discuss what the required elements are for a progress report under Medicare Part B as well as some private/commercial insurance carriers and how often they are required by the Medicare program. Under Medicare Part B, the Centers for Medicare and Medicaid Services (CMS) states the

I often have therapists tell me that they have to do a reevaluation on all of their patient’s every 30 days from the date of the patient’s initial evaluation. I then ask them why they think that is a requirement. Their response is usually along the lines of “Medicare requires we do a reevaluation every 30 days” or “my state practice act requires we do a reevaluation every 30 days” or “my employer or my organization requires we do a reevaluation every 30 days.” In this article, I will address the above 3 responses and explain why it probably is

In last weeks article, “When to Bill For a Reevaluation”, I discussed when it would be appropriate to perform and bill for a reevaluation. In this weeks article, I want to teach you how to account for your time when you are gathering subjective comments from a patient or their caregiver as well as the time you spend gathering objective data to write a Progress Report that may be required by the insurance carrier (i.e. Medicare, Workers Compensation) or due to the patient having a return visit to their physician. To begin, there is no CPT code that exists to

I am often asked what the Centers for Medicare and Medicaid Services (CMS) and other private insurance carriers require in terms of documentation in a progress report. In this article, I will provide the progress note documentation requirements for Medicare Part B, Cigna and several state BCBS insurance carriers. Lets start with the Medicare program and what CMS requires in a progress report for outpatient therapy services paid under Part B benefits. The required elements are as follows:

UnitedHealthcare (UHC) Community Plan has made significant revisions to their Habilitation and Rehabilitation Medical Policy. Revisions include, but are not limited to the following topics: The effective date of the revised medical policy is

UnitedHealthcare (UHC) Community Plan has revised their Speech Language Pathology Services Coverage Determination Guideline. QuestionWhat is the effective date of the revised policy? Answer QuestionWhat state(s) does the revised policy apply to? Answer QuestionWhat are some of the topics discussed in the policy? Answer QuestionHow can I access the revised policy? Answer I hope you found this article informative and helpful. Thank you for being a Gold Member! All material posted on our website is intellectual property of Gawenda Seminars & Consulting, Inc. and can’t be used, reproduced, or posted as your own material without prior written approval of Gawenda

UnitedHealthcare Community Plan has released a revised Coverage Determination Guideline (CDG) for outpatient physical and occupational therapy services for the following states: Arizona California Hawaii Kansas Maryland Michigan New York Ohio Rhode Island Virginia Washington Wisconsin Changes include Required Documentation for the following: Initial Therapy Evaluation/Initial Therapy Visit Requests Request for Continuation of Therapy Visits Progress Reports Re-evaluations Visit Guidelines Signed and Dated Physician Orders To access the revised policy, click I hope you found this information helpful. Thank you for being a Gold Member! All material posted on our website is intellectual property of Gawenda Seminars & Consulting, Inc.

The Centers for Medicare and Medicaid Services (CMS) has released a new booklet where they describe common outpatient rehabilitation therapy services Comprehensive Error Rate Testing (CERT) Program errors, how the CMS calculates improper payment rates, the necessary documentation to support billed Medicare claims, and managing potential overpayments. Some of the more common CERT errors include: