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!

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

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.

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

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

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

The Centers for Medicare and Medicaid Services (CMS) developed the National Correct Coding Initiative (NCCI) edits to combat improper coding that would then lead to inappropriate payment in Medicare Part B claims. CMS owns the NCCI program and is responsible for all decisions regarding its contents. Capital Bridge, LLC is CMS’ contractor for the NCCI. In this article, I will answer some of the more common questions I receive concerning NCCI edits. In addition, I will be presenting a webinar on June 24, 2020 titled “Understanding NCCI Edits & Modifier 59: Version 26.2“. This webinar will provide participants with information on

Effective January 1, 2020, there were 2 new CPT codes to describe dry needling. They are as follows: 20560 – Needle insertion(s) without injection(s), 1 or 2 muscle(s) 20561 – Needle insertion(s) without injection(s), 3 or more muscle(s) Unfortunately, the Centers for Medicare and Medicaid Services (CMS) gave these 2 CPT codes a non-covered status for payment under the Medicare Physician Fee Schedule (MPFS). This meant that if a physical therapist performed dry needling on a Medicare beneficiary who had traditional Medicare as their insurance, CMS would not pay for this service. Since dry needling is non-covered by CMS, this