When to Issue an ABN to a Medicare Beneficiary
When do you issue an advance beneficiary of notice of noncoverage (ABN) to a Medicare beneficiary? An ABN is issued when For additional information on the ABN, click HERE to read my ABN FAQs. Click HERE to read an article when not to issue an ABN to a Medicare beneficiary.
Using Ranges for Frequency and Duration
When developing an outpatient plan of care, can you use ranges for frequency and duration? Under Medicare for outpatient therapy, the Medicare program is
BCBS is Implementing MPPR
A BCBS insurer is implementing the multiple procedure payment reduction (MPPR) policy for outpatient therapy. Who is the insurer? What state is impacted? What outpatient therapy setting does this impact? The insurer is BCBS of
CMS Releases CY 2027 Medicare Physician Fee Schedule Proposed Rule
On July 14, 2026, the Centers for Medicare and Medicaid Services (CMS) released the calendar year (CY) 2027 Medicare Physician Fee Schedule (MPFS) proposed rule. This proposed rule does have regulatory and reimbursement implications for outpatient physical, occupational, and speech therapy provided in all outpatient therapy settings. In this article, I will inform you of what CMS is proposing on the following topics:
Therapy Services Seminar – Knoxville
Understanding the Complex World of Therapy Services: Documentation, CPT Coding, and Billing. This seminar will teach participants the required components of documentation from evaluation through discharge, what interventions are included within each CPT code, the 10 new speech therapy codes for 2027, and how to correctly bill to Medicare, Medicaid, and commercial insurers as it relates to outpatient therapy services.
Using a Physician Order as the Initial Certification for Medicare
Are you aware that you can use a physician order in lieu of a physician signing your initial plan of care? You didn’t? Don’t feel bad, you are not alone! Reviewers at your Medicare Administrative Contractor who are reviewing your outpatient therapy documentation are unaware as well. When Did This Change Occur? What Was The Change? What Criteria Must be Met for an Order to Serve as a POC? Which Frequency and Duration Do I Use? What Outpatient Therapy Settings Does This Change Apply To? Where Can I Obtain Additional Information on this Topic?
Billing an Aetna Medicare Advantage Patient for Noncovered Services
An Aetna Medicare Advantage (MA) patient is coming for outpatient therapy services. You want to provide a service that the MA plan does not cover. You inform the patient of their financial responsibility. The patient agrees to pay you this fee for the noncovered service(s). You think you have done this process correctly. But wait, maybe you have not done it correctly. Contracted providers can’t bill Aetna MA patients for a service not covered under their planunless the provider or the patient obtain
Therapy Services Seminar – Dallas (Frisco)
Understanding the Complex World of Therapy Services: Documentation, CPT Coding, and Billing. This seminar will teach participants the required components of documentation from evaluation through discharge, what interventions are included within each CPT code, the 10 new speech therapy codes for 2027, and how to correctly bill to Medicare, Medicaid, and commercial insurers as it relates to outpatient therapy services.