On April 11, 2022, the Centers for Medicare and Medicaid Services (CMS) released the fiscal year (FY) 2023 proposed rule for skilled nursing facilities for Part A services reimbursed under Patient Driven Payment Model. Comments on the proposed rule must be received by June 10, 2022. To access the proposed rule, click

On April 8, 2021, the Centers for Medicare and Medicaid Services (CMS) issued the fiscal year (FY) 2022 Skilled Nursing Facility (SNF) proposed rule. Comments will be accepted on the proposed rule until 5:00pm on June 7, 2021. The proposed rule is schedule to be published in the Federal Register on April 15, 2021. Highlights of the proposed rule include the following: CMS is proposing to update the SNF payment rates by 1.3% CMS is soliciting broad public comments on a potential methodology for recalibrating the PDPM parity adjustment that would account for the potential effects of the COVID-19 PHE

I am often asked if the time a student treats a Medicare patient for physical, occupational and/or speech therapy services, is that time billable to the Medicare program? In this article, I will answer this question as it applies to inpatient acute care, inpatient rehabilitation facilities, skilled nursing facilities providing Part A therapy services and outpatient therapy settings. QuestionIn the Inpatient Rehabilitation Facility (IRF) setting, do the minutes of therapy provided by the student therapist count towards the required 3-hours of therapy at least 5 days per week? Answer QuestionIn the inpatient hospital acute care setting, can therapy students treat

On July 31, 2020, the Centers for Medicare and Medicaid Services (CMS) released the Skilled Nursing Facility (SNF) Fiscal Year (FY) 2021 final rule titled “Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities; Updates to the Value-Based Purchasing Program for Federal Fiscal Year 2021“. Highlights of the final rule include the following: CMS projects that aggregate Medicare program payments to SNFs will increase by $750 million, or 2.2 percent, for FY 2021 compared to FY 2020. Changes to the ICD-10 code mappings, effective October 1, 2020 to classify SNF patients into payment groups. CMS is finalizing

This article was updated on July 23, 2020 due to Secretary Azar extending the Public Health Emergency due to the COVID-19 pandemic. This article was updated on June 23, 2020 due to CMS clarifying if a practitioner can be out of the country and provide a telehealth visit to a Medicare beneficiary in a state where the practitioner is licensed in. See below for the question and the answer. This article was updated on May 27, 2020 due to the Centers for Medicare and Medicaid Services expanding telehealth coverage for outpatient therapy services to include institutional providers. Please see questions

On April 10, 2020, the Centers for Medicare and Medicaid Services (CMS) released the FY 2021 Skilled Nursing Facility (SNF) proposed rule. To access the Fact Sheet on this proposed rule, click HERE. To access the proposed rule on the Federal Register, click HERE.

The Centers for Medicare and Medicaid Services (CMS) has announced the 2020 Medicare Part A and Part B premiums and deductibles. In this article, I will provide you with what the premiums and deductibles are for 2020 and how the Medicare beneficiaries Part B deductible can impact the annual therapy threshold dollar amount dependent upon was the deductible met before or after they received outpatient physical, occupational and/or speech therapy services. Question What is the 2020 Medicare Part B deductible? Answer Question How does the Part B deductible impact the annual therapy threshold dollar amount? Answer Question What is the

The Centers for Medicare and Medicaid Services (CMS) has released the Fiscal Year 2020 final rule for the Prospective Payment System (PPS) and Consolidated Billing for Skilled Nursing Facilities (SNF). This final rule finalizes the new payment system, Patient Driven Payment Model (PDPM), that goes into effect with dates of service on and after October 1, 2019. In addition, the final rule revises the definition of group therapy under the SNF PPS and updates requirements for the SNF Quality Reporting Program (QRP) and the SNF Value-Based Purchasing (VBP) Program. To access the final rule, click HERE. In addition, Gawenda Seminars