Last week, the Office of the Inspector General (OIG) published 3 enforcement actions involving physical therapy. I will provide a brief summary of the 3 enforcement actions and a link to each action. In the first enforcement action, physical therapist Hatem Behiry was found guilty of participating in a $30 million scheme to defraud Medicare and the New York State Medicaid Program. Per the OIG report, Hatem Behiry “pretended to provide physical therapy to many of those same patients, most of whom were receiving cash kickbacks for coming to the Clinics”. In addition, BEHIRY “also prepared and oversaw the preparation

Noridian Healthcare Solutions will be hosting a free 30-minute webinar on May 21, 2019 at 1:00pm CT to discuss outpatient therapy certifications and recertifications. The webinar will include: Overview What is a Certification When to recertify Signatures Common Errors Resources For additional information and to register, click HERE.

For those of us that treat Medicare beneficiaries for outpatient physical, occupational and/or speech-language pathology services, we all understand that the Medicare program utilizes what as come to be known as the “8-minute rule” when determining how many time-based units can be billed during an outpatient therapy visit. But what about non-Medicare insurance carriers that do not utilize the “8-minute rule”? How do we determine how much time of a time-based CPT code must be provided in order to bill that CPT code to an insurance carrier that does not follow the Medicare “8-minute rule”? In this article, I will

Palmetto GBA, Medicare Administrative Contractor (MAC) for Jurisdiction J which includes the states of Alabama, Georgia and Tennessee, currently has two active medical reviews for outpatient therapy services for non-private practice settings. The two reviews are focused on CPT code 97110 (therapeutic exercise) and CPT code 97140 (manual therapy). When the results of the review are posted, I will write an article on the findings.

On April 5, 2019, the Centers for Medicare and Medicaid Services (CMS) issued the final rule for Medicare Advantage (MA) program (Part C) regulations and Prescription Drug Benefit program (Part D) regulations for calendar year 2020. In this final rule, CMS is implementing several sections of the Bipartisan Budget Act of 2018. One of the sections CMS is implementing is Section 50323 that will allow MA plans to offer “additional telehealth benefits” as part of the government-funded “basic benefits”. Will these “additional telehealth benefits” include physical therapists (PTs), occupational therapists (OTs) and speech-language pathologists (SLPs)? Continue reading to find out.

The Centers for Medicare and Medicaid Services (CMS) has released the fiscal year (FY) 2020 Inpatient Rehabilitation Facility (IRF) proposed rule. Highlights of the proposed rule include: CMS projects that IRF payments will increase by 2.3 percent for FY 2020 Revising the case-mix groups based on two years of data (FY 2017 and FY 2018) from the quality indicator data items and update the relative weights and average length of stay values associated with the revised case-mix groups beginning on October 1, 2019. Proposing 2 new interoperability measures for the IRF rule to implement the final requirements of the IMPACT

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

The Centers for Medicare and Medicaid Services (CMS) has announced a significant change to the use of modifier 59, XE, XP, XS and XU effective July 1, 2019. Currently, the multi-carrier system (MCS) claims system processing logic for modifier 59, XE, XP, XS and XU be appended to the column two CPT code of a procedure to procedure (PTP) edit in order to bypass the edit and allow both CPT codes to be paid by the Medicare Administrative Contractor (MAC). Beginning with dates of service on and after July 1, 2019, the CMS will Click HERE to view the latest