I recently had a question submitted to me by one of my Gold Members. Here is the situation and question. We had a patient who had an auto insurance that was in litigation that settled; however, we did not even get 50 percent of what we charged. Are we allowed to bill the secondary for the remainder for payment? The secondary insurance is Medicare. Here is information I found that may assist you in the future if you encounter this situation. According to the Centers for Medicare and Medicaid Services,

On December 20, 2018, the Centers for Medicare and Medicaid Services (CMS) revised MLN Matters Number SE 17036 to remove the Admission order requirement from the portion of the article under “Required documentation elements for an IRF claim include, but are not limited to.” To access this ML Matters revision, click HERE. In addition, CMS did clarify the use of students treating Medicare beneficiaries in the inpatient rehab setting. For the latest information on this topic, click HERE.

During a November 15, 2018 Inpatient Rehabilitation Facility (IRF) phone call, a Centers for Medicare and Medicaid Services (CMS) representative stated that according to hospital conditions of participation that Inpatient Rehabilitation Facilities (IRFs) must meet, students do not have a role in providing therapy or therapy minutes to patients, even under direct supervision of the licensed therapist. On December 11, 2018, the American Physical Therapy Association (APTA), American Occupational Therapy Association, and American Speech-Language-Hearing Association participated in a meeting with CMS. During the meeting, CMS indicated that there had been

Is functional limitation reporting ending at the end of 2018? The answer depends on what insurance carrier you are asking about. For traditional Medicare Part B beneficiaries, functional limitation reporting (FLR)

Question How does CMS calculates the penalty for those choosing not to participate/report? Answer Question Regarding the Improvement Activities, how can we determine which Improvement Activities are considered high-weighted and which are considered medium-weighted? Answer Question How do we go about opting in and when is the deadline? Answer Question If we have 11 therapists and 7 physicians but all therapy billing is incident to the physician, are we classified as a small practice since we only have 7 physicians? Answer Question If we are excluded from MIPS, do not want to opt-in to MIPS and we submit via claims, is

The Merit-Based Incentive Payment System (MIPS) in 2019 will now include physical therapists, occupational therapists and speech-language pathologists that treat Medicare beneficiaries in the private practice setting. The simplest way to know if you are a private practice under the Medicare program is that you submit claims to your Medicare Administrative Contractor on a 1500-claim form. Over the next several weeks, I will be answering question I receive on the MIPS program to help you get prepared. In addition, I will be presenting a 2.5 hour MIPS webinar tomorrow, December 18, 2018 from 1:00pm – 3:30pm ET. For additional information

The Merit-Based Incentive Payment System (MIPS) in 2019 will now include physical therapists, occupational therapists and speech-language pathologists that treat Medicare beneficiaries in the private practice setting. The simplest way to know if you are a private practice under the Medicare program is that you submit claims to your Medicare Administrative Contractor on a 1500-claim form. Over the next several weeks, I will be answering question I receive on the MIPS program to help you get prepared. In addition, I will be presenting a 2.5 hour MIPS webinar on December 18, 2018 from 1:00pm – 3:30pm ET. For additional information

A question I often receive is what CPT codes does the so called “8-minute rule” apply to? Does it apply to just the 15-minute time-based CPT codes or does it also apply to the 1-hour time-based CPT codes as well as the untimed, supervised modality CPT codes and untimed evaluation CPT codes? The “8-minute rule” applies to all CPT codes