When is Medicare Primary or Secondary

There remains much confusion how to bill for outpatient therapy services when an outpatient therapy patient is entitled to Medicare, but may also be covered by a group health plan (GHP) or a non-group health plan (NGHP), such as workers compensation or auto no-fault, being primary. In this article, I will answer the following questions:

Medicare Estimated Payments for Outpatient Therapy in 2023

Gawenda

On November 1, 2022, the Centers for Medicare and Medicaid Services (CMS) released the calendar year (CY) 2023 final rule for services reimbursed under the Medicare Physician Fee Schedule (MPFS). Click HERE to read my summary on the final rule that will impact outpatient physical, occupational and speech therapy services in 2023. On December 22, 2022 and December 23, 2022, the United States Senate and United States House of Representatives, respectively, passed the Consolidated Appropriations Act, 2023. Included in this legislation was Congress providing additional funding to the Medicare program to help offset some, but not all, of the 4.47% … Read More

2023 Update on Telehealth

Due to passage of the Consolidated Appropriations Act, 2023, the Centers for Medicare and Medicaid Services will reimburse for outpatient therapy services provided by physical therapists, occupational therapists and speech-language pathologists delivered via telehealth in all outpatient settings through

Understanding the ABN for Outpatient Therapy Services

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Gawenda

This 1-hour webinar will teach participants when they can and can’t issue an advance beneficiary notice of noncoverage (ABN) to a Medicare beneficiary, how to complete the ABN form correctly and provide answers to many of the questions providers of therapy services have regarding the ABN.

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