Each year, the Centers for Medicare and Medicaid Services (CMS) issues the dollar amount that must be met in order to appeal to the Administrative Law Judge (ALJ). For calendar year 2026, that dollar amount is

As of October 20, 2025, the government remains in a shutdown. What does the shutdown mean for coverage and payment of outpatient therapy services under the Medicare program? Here is the latest:

Due to the continued government shutdown, CMS has instructed all Medicare Administrative Contractors to continue to hold claims for all services reimbursed under the Medicare Physician Fee Schedule. Update from CMS: In light of the continuing government shutdown, CMS will continue to process and pay held claims in a timely manner with the exception of select claims for services impacted by the expired provisions.  Claims impacted by the expired provisions include outpatient therapy delivered via telehealth. In addition, several localities are impacted by the geographic price cost index (GPCI) minimum work floor of 1.0. On October 1, 2025, that legislation

A question that comes up every so often is how often can I submit claims to an insurance carrier for a patient receiving outpatient therapy services. The answer actually depends on how your practice/organization is classified. In this article, I will answer the following questions:

As a private practice owner, you have made the decision to go out-of-network (OON) with an insurer. You are now trying to identify the benefits and risks of submitting a claim to the insurer or providing the patient with a superbill. In this third article of this 3-part series, I will answer the following questions:

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:

The Centers for Medicare and Medicaid Services (CMS) has released the 2019 MIPS quality measures available to report by physical therapists (PT’s), occupational therapists (OT’s) and speech-language pathologists (SLP’s) that practice in the private practice setting. In this article, I will provide the measures available to PT’s, OT’s and SLP’s reporting via claims and registry. Quality Measures That Can Be Reported via Claims by Physical Therapists Quality Measures That Can Be Reported via Registry by Physical Therapists Quality Measures That Can Be Reported via Claims by Occupational Therapists Quality Measures That Can Be Reported via Registry by Occupational Therapists Quality