Wisconsin Physician Services (WPS) will host a webinar on Coverage Criteria and Documentation on June 18, 2015 in East Lansing, MI. The seminar will explore the coverage criteria and documentation requirements for physical therapy, occupational therapy, and speech language pathology. In this interactive session we will review the coverage criteria as well as actual documentation examples. For additional information and to register, click HERE. Wisconsin Physician Services (WPS) will host a billing and payment seminar on June 18, 2015 in East Lansing, MI. The seminar will include the following: CMS regulations and coverage, resources to understand the billing and payment, Advance

I often receive this question from people around the United States. The Medicare beneficiary has exceeded their annual therapy cap dollar threshold and they have a secondary insurance that will pay for therapy above the cap, how do I get the Medicare program to deny so that I can bill the secondary? Here is my usual response to this question. If the therapist feels the therapy they are providing is

On March 26, 2015, the United States House of Representatives passed H.R. 2, the Medicare Access and CHIP Reauthorization Act, by a vote of 392-37. This legislation permanently repeals the flawed sustainable growth rate (SGR) formula, thereby avoiding the scheduled 21.2% reduction that is to go into effect on April 1, 2015 and provides a 0.5% increase in payments under the Medicare Physician Fee Schedule beginning this year and continuing through 2019. This legislation also extends the therapy cap exception process for outpatient therapy services through December 31, 2017. This legislation was then sent to the Senate; however, the Senate

Noridian Healthcare Solutions, Medicare Administrative Contractor for the states of Alaska, Arizona, Idaho, Montana, North Dakota, Oregon, South Dakota, Utah, Washington, and Wyoming, will be hosting a 1.5 hour workshop on March 10, 2015 on outpatient therapy. Topics will include: Functional G-Code Billing Documentation Exception Billing – KX Modifier Signature Requirements ABN Usage Resources For additional information and to register, click HERE.

National Government Services (NGS) has issued policy education on functional limitation reporting (i.e. Medicare G-Codes) for outpatient therapy services. This education focuses on the reporting of G-codes throughout an episode of care for a Medicare beneficiary. To access the policy education, click

With approximately 15 million Medicare beneficiaries enrolled in Medicare Advantage plans under Medicare Part C, I am often asked if the Medicare Advantage plans follow the same rules as traditional Medicare for outpatient therapy services in terms of Functional Limitation Reporting, the application of the Multiple Procedure Payment Reduction policy, PQRS for private practices, CCI edits and the use of modifier-59, using the therapy specific modifiers (i.e. GN, GO, GP), and the application of the Medicare therapy cap, just to name a few. While Medicare Advantage plans must follow certain federal guidelines, they are offered by private insurance carriers such

If Congress does not pass additional legislation either eliminating the therapy cap or extending the exception process prior to April 1, 2014, Medicare beneficiaries will not have coverage for outpatient therapy services once they exceed $1920 PT and SLP combined or a separate $1920 for occupational therapy. If no legislation is passed and no exception process is in place, therapy provided above the $1920 would be considered

Section 603(c) of the American Taxpayer Relief Act of 2012 (ATRA) changed the payment liability for denials resulting from the outpatient therapy caps from beneficiaries to providers effective January 1, 2013. Medicare systems were not updated in time to accurately represent this change on provider remittance advices (RAs). Medicare contractors may have already processed therapy cap denials for services provided in 2013. These denials incorrectly report on RAs beneficiary liability (Group Code “PR”) when liability legally rests with the provider (Group Code “CO”). Due to differing claims processing system constraints, this inaccurate RA reporting will be corrected beginning on different