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:

There are many modifiers providers of therapy services are use to adding to CPT codes on the claim forms. Common modifiers include the KX modifier, 59-modifier and therapy specific modifiers of GN, GO and GP. But do you know the following modifiers and when to use them: GA, GX, GY and GZ? In this article, I will discuss when to use these modifiers on a CPT code on the claim form for therapy services. In addition, if you have additional questions on when to issue an advance beneficiary notice of non-coverage (ABN) form to a Medicare beneficiary, check out my

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:  

As many of you have found out the hard way, the Centers for Medicare and Medicaid Services (CMS) implemented a new program called Targeted Probe and Educate (TPE) where the goal of the program is to help providers and suppliers reduce claim denials and appeals through one-on-one education. CMS uses data analysis to identify providers and suppliers who have high claim error rates or unusual billing practices, and items and services that have high national error rates and are a financial risk to Medicare. Upon data analysis, if you are not an outlier in any of the above areas, you