Current News



How Does CMS Determine the Payment of a CPT Code

Two questions I am often asked is how does the Centers for Medicare and Medicaid (CMS) determine the payment for each CPT code and why is the same CPT code paid differently depending on where the practice or facility is located? In this article, I will answer how CMS determines the payment for each CPT code and why the same CPT code reimburses differently based on the location of your practice or organization. QuestionHow does CMS determine the payment for each CPT code? Answer QuestionWhat is included in the work relative value unit (RVU) of a CPT code? Answer QuestionWhat

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CMS Releases FY 2021 IRF Final Rule

On August 4, 2020, the Centers for Medicare and Medicaid Services (CMS) released the fiscal year (FY) 2021 Final Rule for Inpatient Rehabilitation Facilities (IRFs). Highlights of the final rule include: Permanent elimination of the post-admission physician evaluation effective October 1, 2020 CMS is finalizing that a non-physician practitioner (NPP) may perform one of the three required visits in lieu of the physician in the second and later weeks of a patient’s care, when consistent with the NPP’s state scope of practice Overall IRF payment update for FY 2021 of 2.8% To access the Final Rule, click HERE. To access

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Renewed ABN Form Mandatory January 2021

This article was updated on August 3, 2020 as CMS did change the effective date. Per the Centers for Medicare and Medicaid Services, the Advance Beneficiary Notice of Noncoverage (ABN), Form CMS-R-131, and form instructions have been approved by the Office of Management and Budget (OMB) for renewal. The use of the renewed form with the expiration date of 06/30/2023 will be mandatory on I hope you found this article helpful. Thank you for being a Gold Member!

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July 2020 Telehealth Updates

With the Secretary of the Department of Health and Human Services extending the Public Health Emergency (PHE) due to the COVID-19 pandemic, many private practices as well as facilities and organizations want to know what does this mean for the extension of providing outpatient therapy services via telehealth. In this article, I will provide updates on outpatient therapy services delivered via telehealth for the traditional Medicare Part B program and some of the larger national insurance carriers. Medicare (Traditional) Aetna Anthem BCBS of Colorado Anthem BCBS of Connecticut Anthem BCBS of Georgia Anthem BCBS of Indiana Anthem BCBS of Kentucky

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CMS to Resume Medical Reviews August 3, 2020

The Centers for Medicare and Medicaid has announced they expect to discontinue exercising enforcement discretion regarding medical reviews beginning on August 3, 2020, regardless of the status of the public health emergency. This includes pre-payment medical reviews conducted by MedicareAdministrative Contractors (MACs) under the Targeted Probe and Educate (TPE) program, and postpayment reviews conducted by the MACs, Supplemental Medical Review Contractor (SMRC) reviews and Recovery Audit Contractor (RAC). Click HERE to read it straight from CMS. I hope you found this information helpful.

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CMS to Recognize Therapy Interstate License Compacts

The Centers for Medicare and Medicaid Services (CMS) has announced they will accept interstate license compacts for Physical Therapy, Occupational Therapy and Speech Language Therapy as valid, full licenses for the purposes of meeting CMS’ federal license requirements. A physical therapist, occupational therapist or speech-language pathologist working under the authorization of a compact must meet both the licensure requirements outlined in the primary state of residence and thoseestablished by the compact laws adopted by the legislatures of the interstate compact states. CMS states that the Medicare Administrative Contractors (MACs) will accept CMS-855 enrollment applications from providers reporting an interstate license

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CMS Releases CY 2021 Home Health Proposed Rule

On June 25, 2020, the Centers for Medicare and Medicaid Services (CMS) released “Medicare and Medicaid Programs: CY 2021 Home Health Prospective Payment System Rate Update; Home Health Quality Reporting Requirements; and Home Infusion Therapy Services Requirements“. Per the summary, “This proposed rule would update the home health prospective payment system(HH PPS) payment rates and wage index for calendar year (CY) 2021. This proposed rule alsoproposes to make permanent the changes to the home health regulations regarding the use oftechnology in providing services under the Medicare home health benefit as described in theMedicare and Medicaid Programs; Revisions in Response to

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Hospitals: Telehealth vs Remote Services – What’s the Difference?

Due to the Public Health Emergency due to the COVID-19 pandemic, the Centers for Medicare and Medicaid Services has issued many waivers regarding how hospitals can deliver outpatient therapy services to their Medicare Part B beneficiaries. In this article, I will discuss the “Hospitals without Walls” and the expansion of telehealth services and explain the difference in the 2 including how to bill for each type of service. QuestionWhat is “Hospitals without Walls” and how does this allow hospitals to provide outpatient therapy services to Medicare Part B beneficiaries in their home? Answer QuestionCan hospitals provide outpatient physical, occupational and

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