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08/05/20

CMS Releases Hospital OPPS CY 2021 Proposed Rule

On August 4, 2020, the Centers for Medicare and Medicaid Services (CMS) released the calendar year (CY) 2021 proposed rule titled “Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs; New Categories for Hospital Outpatient Department Prior Authorization Process; Clinical Laboratory Fee Schedule: Laboratory Date of Service Policy; Overall Hospital Quality Star Rating Methodology; and Physician-owned Hospitals.“ Highlights of the proposed rule include: CMS is proposing to eliminate the Inpatient Only (IPO) list over a three-year transitional period with the list completely phased out by CY 2024 CMS is proposing to expand the

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07/29/20

Hospitals: Providing Services Remotely versus Telehealth

With the Centers for Medicare and Medicaid Services (CMS) expansion of telehealth services as well as their Hospital Without Walls initiative, many hospitals are confused on the differences between providing outpatient physical, occupational and speech therapy services remotely versus via telehealth and how to complete the UB-04 claim form. I published an article on June 18, 2020 explaining the differences between the two and how to do the billing for each type of service. Now, CMS has provided additional clarification on providing outpatient physical, occupational and speech therapy services remotely versus via telehealth and explains how to do the billing

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07/17/20

July 2020 Update of the Hospital Outpatient Prospective Payment System

The Centers for Medicare and Medicaid Services (CMS) has published a revised edition of MLN Matters Number: MM11814 on July 16, 2020 that provides an update of the Hospital Outpatient Prospective Payment System (OPPS). This update contains information on the Telephone Services CPT codes (98966 – 98968) as well as the virtual check-in and E-Visit Level II HCPCS Codes (G2010, G2012, and G2061-G2063). Click HERE to access MM11814.

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05/18/20

Medicare Telehealth Questions and Answers

This article was updated on July 23, 2020 due to Secretary Azar extending the Public Health Emergency due to the COVID-19 pandemic. This article was updated on June 23, 2020 due to CMS clarifying if a practitioner can be out of the country and provide a telehealth visit to a Medicare beneficiary in a state where the practitioner is licensed in. See below for the question and the answer. This article was updated on May 27, 2020 due to the Centers for Medicare and Medicaid Services expanding telehealth coverage for outpatient therapy services to include institutional providers. Please see questions

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05/06/20

Can Hospital Therapy Departments Provide Telehealth Services

This article was updated on May 21, 2020. See below for updated answers. On April 30, 2020, the Centers for Medicare and Medicaid Services (CMS) temporarily expanded who can provide and be paid for telehealth services under the Medicare Part B program to now include physical therapists, occupational therapists and speech-language pathologists. It was clear that this expansion of telehealth services included therapist-owned and physician-owned private practices but were unclear if this also included hospital outpatient therapy departments. Well, as of May 5, 2020, we now know the answer. QuestionCan a hospital outpatient therapy department be paid for a telehealth

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04/09/20

Hospitals, E-Visits and the UB-04 Claim Form

The Centers for Medicare and Medicaid Services (CMS), due to the Public Health Emergency (PHE) due to COVID-19 Pandemic, are allowing physical therapists (PTs), occupational therapists (OTs) and speech-language pathologists (SLPs) to provide the following services: G2010: Remote evaluation of recorded video and/or images submitted by an established patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 business hours, not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment G2012: Brief communication technology-based service, e.g.

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11/11/19

Medicare 2020 Deductibles and Premiums Announced

The Centers for Medicare and Medicaid Services (CMS) has announced the 2020 Medicare Part A and Part B premiums and deductibles. In this article, I will provide you with what the premiums and deductibles are for 2020 and how the Medicare beneficiaries Part B deductible can impact the annual therapy threshold dollar amount dependent upon was the deductible met before or after they received outpatient physical, occupational and/or speech therapy services. Question What is the 2020 Medicare Part B deductible? Answer Question How does the Part B deductible impact the annual therapy threshold dollar amount? Answer Question What is the

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03/04/19

CMS Updates Hospital Compare Data

Do you want to know how your hospital compares to other hospitals? Check out the latest Hospital Compare data that was updated on February 28, 2019 by clicking HERE.

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