Current News

News

08/01/22

Must Medicare Advantage Plans Cover Maintenance Therapy

QuestionMust Medicare Advantage plans cover maintenance therapy in the same manner that traditional Medicare covers maintenance therapy? Answer

Read More
08/01/22

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

Read More
07/26/21

Hospice and Outpatient Therapy

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

Read More
07/13/21

CMS Releases CY 2022 Proposed Rule for Outpatient Therapy

On July 13, 2021, the Centers for Medicare and Medicaid Services (CMS) released the calendar year (CY) 2022 proposed rule for services reimbursed under the Medicare Physician Fee Schedule (MPFS). This rule does apply to outpatient physical, occupational and speech therapy services provided in all outpatient therapy settings except a critical access hospitals. This proposed rule only applies to traditional Medicare and not Medicare Advantage plans. Highlights of the final rule include, but are not limited to, the following: CO and CQ Assistant Modifiers Payment Reduction Calculation Adding Therapy Services to the List of Medicare Telehealth Services Therapy Codes Removed

Read More
04/26/21

Do Medicare Beneficiaries Have Unlimited Outpatient Therapy Benefits?

One of my Medicare patients called the Medicare program to ask them about outpatient therapy benefits and they were told that they have unlimited outpatient therapy benefits. Is that true? Let me provide the answer to that question below with the reference to support my answer. QuestionDo Medicare beneficiaries have unlimited outpatient therapy benefits? Answer I hope this article has assisted you in explaining outpatient therapy benefit coverage to your Medicare beneficiaries. Thank you for being a Gold Member!

Read More
09/21/20

Must I Enroll in TRICARE to Treat TRICARE Patients

As more and more practices choose not to enroll with commercial insurance carriers, including Medicare Advantage programs, a common question I am asked is must I enroll with TRICARE to be able to provide outpatient therapy services to TRICARE beneficiaries. In this article, I will provide the answers (with resources) to some of the more common questions I receive. QuestionMust I enroll with TRICARE to be able to provide outpatient therapy services to TRICARE beneficiaries? Answer QuestionWhat does TRICARE mean when they state “any TRICARE-authorized provider who hasn’t joined the network is a non-network provider? Answer QuestionCan a physical therapist

Read More
08/03/20

CMS Releases CY 2021 Proposed Rule for Services Paid Under the MPFS

The Centers for Medicare and Medicaid Services (CMS) has released the calendar year (CY) 2021 Proposed Rule for services paid under the Medicare Physician Fee Schedule (MPFS). This would include outpatient physical, occupational and speech therapy services provided in all settings (private practice (both therapist-owned and physician-owned, skilled nursing facilities doing Part B, comprehensive outpatient rehabilitation facilities, rehabilitation agencies, home health agencies providing Part B therapy services in the home and hospital outpatient therapy departments). This proposed rule would not apply to outpatient therapy services provided by critical access hospitals (CAHs) since CAHs are not reimbursed under the MPFS. Highlights

Read More
07/29/20

Hospitals: Providing Services Remotely versus Telehealth

With the Centers for Medicare and Medicaid Services (CMS) expansion of telehealth services as well as their Hospital Without Walls initiative, many hospitals are confused on the differences between providing outpatient physical, occupational and speech therapy services remotely versus via telehealth and how to complete the UB-04 claim form. I published an article on June 18, 2020 explaining the differences between the two and how to do the billing for each type of service. Now, CMS has provided additional clarification on providing outpatient physical, occupational and speech therapy services remotely versus via telehealth and explains how to do the billing

Read More