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05/27/24

Medicare’s 8-Minute Rule: Who Does it Apply To?

The Centers for Medicare and Medicaid Services (CMS) implemented what has become known as the “8-minute rule” on April 1, 2000. We all know this rule applies to traditional Medicare and outpatient therapy, but what about Medicare Advantage, federal insurance carriers, Medicaid, and commercial insurance carriers? In this article, I will answer the following questions:

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03/04/24

Does Aetna Medicare Advantage Follow Medicare’s “8-Minute Rule”?

A question I am often asked is do all Medicare Advantage (MA) plans follow traditional Medicare’s “8-minute rule”. The answer depends on the MA plan. Regarding Aetna MA and do they follow Medicare’s “8-minute rule”, the answer is

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03/13/23

Does Aetna Medicare Advantage Follow Medicare’s “8-Minute Rule”?

In this article, I will answer the following questions:

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10/24/22

Do MIPS Payment Adjustments Apply to Medicare Advantage Plans

In this article, I will answer the following questions regarding the Merit-Based Incentive Payment System (MIPS) and the applicable payment adjustments and how they apply to Medicare Advantage plans:

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08/01/22

Must Medicare Advantage Plans Cover Maintenance Therapy

QuestionMust Medicare Advantage plans cover maintenance therapy in the same manner that traditional Medicare covers maintenance therapy? Answer

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08/01/22

Do Medicare Advantage Plans Require 10th Visit Progress Reports?

QuestionDoes the 10th visit Progress Report that applies to traditional Medicare patients also apply to all Medicare Advantage plans and their respective beneficiaries? Answer

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08/01/22

Do Medicare Advantage Plans Require Signed Plans of Care?

QuestionI know traditional Medicare requires a dated signature of the physician or nonphysician practitioner (NPP) whom the Medicare beneficiary is under their care while receiving outpatient physical, occupational and/or speech therapy services. Does this same requirement apply to Medicare Advantage plans whose beneficiaries are receiving outpatient physical, occupational and/or speech therapy services? Answer

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06/20/22

Does Sequestration Reduction Apply to Medicare Advantage Plans

Due to COVID-19, the 2% sequestration reduction for traditional Medicare was placed on pause until April 1, 2022. Beginning with dates of service between April 1 – June 30, 2022, the sequestration reduction returned at 1% and then increases to 2% for dates of service on and after July 1, 2022. What therapy providers want to know is does the sequestration reduction also automatically apply to Medicare Advantage plans? The answer is

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