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01/25/21

Can I Collect Medicare’s Part B Deductible at Time of Service

QuestionAm I allowed to collect a Medicare beneficiaries annual Part B deductible at the time of service if I know they have not yet met their deductible for the applicable calendar year? Answer I hope you found this article helpful and you now have a better understanding about collecting a Medicare beneficiaries deductible prior to the Medicare program paying the claim. Thank you for being a Gold Member!

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01/18/21

Qualified Medicare Beneficiary Program

Lately, I have been receiving questions regarding Medicare beneficiaries who are dually eligible (have Medicare primary and Medicaid secondary) and are enrolled in the Qualified Medicare Beneficiary (QMB) program. Medicare beneficiaries enrolled in the QMB program are also enrolled in Medicaid and get help with their Medicare premiums and cost-sharing. What providers want to know is can they bill the Medicare beneficiary who is enrolled in the QMB program for the 20% co-insurance the Medicare program does not cover as well as any deductible the Medicare beneficiary has not met yet if the Medicaid program does not pay that portion?

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11/16/20

Can Students Treat Medicare Patients and Bill For Those Services?

I am often asked if the time a student treats a Medicare patient for physical, occupational and/or speech therapy services, is that time billable to the Medicare program? In this article, I will answer this question as it applies to inpatient acute care, inpatient rehabilitation facilities, skilled nursing facilities providing Part A therapy services and outpatient therapy settings. QuestionIn the Inpatient Rehabilitation Facility (IRF) setting, do the minutes of therapy provided by the student therapist count towards the required 3-hours of therapy at least 5 days per week? Answer QuestionIn the inpatient hospital acute care setting, can therapy students treat

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11/09/20

Medicare 2021 Deductibles and Premiums Announced

The Centers for Medicare and Medicaid Services (CMS) has announced the 2021 Medicare Part A and Part B premiums and deductibles. In this article, I will provide you with what the premiums and deductibles are for 2021 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 2021 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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10/19/20

Can a Resident Certify a Therapy Plan of Care

QuestionCan a resident physician certify and recertify a plan of care for outpatient therapy services under the Medicare program? Answer If you have other questions about Medicare Part B and outpatient therapy plans of care, click HERE. If you have questions about Medicare Part B outpatient therapy certifications and recertifications, click Here.

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10/12/20

Effective Date of Enrollment and Retrospective Billing Date

When a physical therapist, occupational therapist or speech-language pathologist in private practice enrolls in the Medicare program, how does the Centers for Medicare and Medicaid Services (CMS) determine the effective date of enrollment and what are the requirements for retrospective billing and how many days can you bill for services prior to the effective date of your enrollment? In this article, I will answer these questions. Question How is the effective date determined? Answer QuestionWhat are the retrospective billing requirements and limitations? Answer QuestionCan you give an example of the difference between Effective Date of Enrollment and Retrospective Billing Date?

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09/08/20

CMS Reinstates Therapy NCCI Edits

The Centers for Medicare and Medicaid Services (CMS) has reinstated many of the procedure-to-procedure (PTP) edits, known more commonly as the National Correct Coding Initiative (NCCI) edits, for physical therapy, occupational therapy, and speech therapy outpatient therapy services that they had deleted earlier this year. The reinstated NCCI edits were published by CMS on September 1, 2020 and become effective with dates of service beginning on October 1, 2020. CPT codes affected include, but are not limited to, the following: Biofeedback codes (CPT codes 90912 and 90913) Speech therapy evaluations (CPT codes 92521-92524) Speech therapy treatment and treatment of dysphagia

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08/31/20

Medicare Advantage and OON Questions and Answers

Lately, I have been receiving questions from providers who are not contracted with Medicare Advantage plans and who want to know if they can evaluate and treat those patients and charge them cash. In this article, I will answer the following questions: I’m enrolled in the Medicare program as a participating provider and not enrolled with the Medicare Advantage (MA) plan. The MA plan does have out-of-network (OON) benefits. Must I submit a claim to the MA carrier and are there limitations in how much I can charge the patient? I’m enrolled in the Medicare program as a non-participating provider

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