Lately, I have been receiving questions via email and on various social media platforms concerning providing outpatient therapy services to a Medicare beneficiary who is in hospice. What people want to know is does the Medicare program pay a therapy provider separately for outpatient therapy services that they provide to a Medicare beneficiary who is in hospice? Let me answer this question for you as well as several other questions related to this topic. Question Does the Medicare program pay a therapy provider for outpatient therapy services that they provided to a Medicare beneficiary who is in hospice? Answer Question

More and more physical therapists (PTs), occupational therapists (OTs) and speech-language pathologists (SLPs) are establishing private practices that focus on seeing patients in their home for outpatient therapy services. The Centers for Medicare and Medicaid Services (CMS) does allow PTs, OTs, and SLPs to treat Medicare beneficiaries in their home as outpatients and pays for those services under the Medicare Physician Fee Schedule just as CMS would pay if the Medicare beneficiary went to a private practice or other outpatient therapy setting (except for a critical access hospital who is reimbursed on a cost-ratio basis). However, what is considered a

Lately, I have been receiving questions what a therapist must do when an active outpatient therapy patient becomes Medicare eligible during an episode of care. In this article, I will answer the following questions: When an outpatient therapy patient becomes Medicare eligible during an episode of care, must I perform another evaluation or a reevaluation? When an outpatient therapy patient becomes Medicare eligible during an episode of care, when would I establish the plan of care and have it certified by their physician or non-physician practitioner (NPP)? When an outpatient therapy patient becomes Medicare eligible during an episode of care,

Ever since the Centers for Medicare and Medicaid Services (CMS) implemented the Targeted Medical Review process, providers of outpatient therapy services have referred to this as the “second cap”, the “second tier”, or the “second threshold” with the “first cap” or “first tier” being the annual therapy threshold (formerly called the therapy cap). In this article, I will answer common questions I receive on the annual therapy threshold and the targeted medical review and provide criteria on how claims may be selected for a targeted medical review. QuestionWhat is annual therapy threshold dollar amount for calendar year 2021? Answer QuestionIn

The Centers for Medicare and Medicaid Services (CMS) has updated the list of outpatient physical, occupational and speech therapy services that can be delivered via telehealth during the COVID public health emergency (PHE). The additional CPT codes added are as follows: 92526 92607 92608 92609 92610 92626 92627 96105 96125 97129 97130 To view the entire list of CPT codes that can be delivered via telehealth and reimbursed by CMS, click HERE. Remember that once the PHE is declared over, physical therapists, occupational therapists and speech-language pathologists will no longer be able to be reimbursed by the Medicare program for

I receive several questions per week regarding the supervision requirements of student physical, occupational and speech therapists, student physical therapist assistants and student occupational therapy assistants when they are treating Medicare patients. In this article, I will give the answers to the following questions: What are the supervision requirements of students when they are treating Medicare beneficiaries receiving outpatient therapy services? What are the supervision requirements of students when they are treating Medicare beneficiaries receiving therapy services in a skilled nursing facility under Part A benefits? What are the supervision requirements of students when they are treating Medicare beneficiaries receiving

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!

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?