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RACs

RAC Therapy Reviews Underway: 2014 Therapy Claims

RAC Therapy Reviews Underway: 2014 Therapy Claims

RAC therapy reviews are underway as CMS paved the way for manual medical review of therapy claims over the $3700 threshold by the Recovery Auditors (RACs). Effective January 16th CMS provided a contract addendum to the current (outgoing) RACs in all 4 regions to begin a review of therapy claims over $3700 submitted between March […]

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February 26, 2015 3 Comments
$3700 Therapy Threshold RAC Reviews

$3700 Therapy Threshold RAC Reviews

$3700 therapy threshold RAC reviews have resumed even though the larger RAC program has been “paused”.  Therapy over the $3700 per beneficiary thresholds ($3700 for PT & SLP combined, another $3700 for OT) is mandatorily reviewed for medical necessity.  CMS has assigned the review task to the RACs.  According to information provided by CMS to the […]

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December 4, 2014 1 Comment
RAC Restart Facts…(Not Rumors)..So Far

RAC Restart Facts…(Not Rumors)..So Far

The therapy community is abuzz with all the rumors and misinformation on the RAC restart facts. So far there are a few things that we do know.  We know that CMS wrote letters to members of Congress on Friday August 1st announcing their intention to have a limited restart to the “paused” RAC program. We also know […]

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August 12, 2014 2 Comments
CMS to Restart Some RAC Reviews

CMS to Restart Some RAC Reviews

CMS announced today that it is initiating contract modification with the current Recovery Auditors in Regions A, B, C and D to restart reviews of a limited number of issues.  While CMS had previously announced that new Recovery Auditor (RAC) contracts would be announced for Regions 1-5 no later than August 15th their announcement today […]

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August 4, 2014 3 Comments

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Compliance

New Physical Therapy Codes for 2017

New Physical Therapy Codes for 2017

New physical therapy codes for 2017 were released yesterday by CMS as part of the Medicare Physician Fee Schedule Proposed Rule for 2017 (CMS-1654-P).  The therapy community has long awaiting the anticipated changes to the current CPT coding structure.  The proposed rule provides information on the new physical therapy and occupational therapy evaluation codes (we […]

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July 8, 2016 3 Comments
Therapy Manual Medical Review Again

Therapy Manual Medical Review Again

Here we go again!  Therapy manual medical review again! Just when the therapy community, particularly those in private practice, were thinking that CMS forgot about manual medical review of outpatient therapy over $3700 CMS opted a stealth move, the though an update to the therapy cap website.  It represents a long-awaited announcement, but not a particularly welcome […]

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July 5, 2016 2 Comments
2016 PQRS Measures for Occupational Therapy

2016 PQRS Measures for Occupational Therapy

There is no change in 2016 PQRS measures reporting for occupational therapy for claims based reporting.  As the new year begins occupational therapists, much like physical therapists, may find themselves in one of three situations regarding PQRS reporting:  1) Successful reporting in 2014, and therefore no reductions to Medicare payments in 2016. 2) Notification that 2014 reporting […]

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January 3, 2016 0 Comments
2016 PQRS Measures for Physical Therapy

2016 PQRS Measures for Physical Therapy

Time to get started to with 2016 PQRS measures for physical therapy!  As the new year begins physical therapists may find themselves in one of three situations regarding PQRS reporting:  1) Successful reporting in 2014, and therefore no reductions to Medicare payments in 2016. 2) Notification that 2014 reporting was unsuccessful and therefore a 2% […]

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January 1, 2016 1 Comment