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Archive for February, 2014

Occupational Therapy PQRS

February 28, 2014 2 Comments
Occupational Therapy PQRS

There are 9 occupational therapy PQRS measures in 2014 for claims-based reporting (free).  Many are the same measure for physical therapy reporting, however there are some different options for occupational therapy.  Before we get to the measures, it’s important to clear up some misunderstanding about the minimum number of measure that must be successfully reported […]

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Therapy PQRS – Are You Reporting Correctly?

February 26, 2014 2 Comments
Therapy PQRS – Are You Reporting Correctly?

PQRS measures and reporting have changed for 2014, and if you are not aware of the changes, your reporting could cost you 2% of your 2016 payments from Medicare!  For physical therapists doing claims based reporting there are 8 eligible measures, and for occupational therapists there are 9 eligible measures.  Therapists must report at least 9 […]

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RAC Work Pause and Therapy Manual Medical Review

February 24, 2014 1 Comment
RAC Work Pause and Therapy Manual Medical Review

The CMS RAC Work pause of the Recovery Auditor (RAC) program will provide some work load relief for outpatient therapy providers in the short run, but in the long run 100% of therapy claims over the $3700 thresholds will be reviewed.  So what does this mean for therapy providers?  Check your mail, if you are […]

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Inclement Weather Can Threaten SNF Revenue

February 21, 2014 0 Comments
Inclement Weather Can Threaten SNF Revenue

With all the snow and treacherous weather hitting the northern (and some southern) states, knowing the rules surrounding the unscheduled RUG assessments is key to maintaining your revenue. Most of the unscheduled assessments are self-explanatory, however the Chang of Therapy (COT) assessment can wreak havoc in your MDS department when bad weather strikes. As you […]

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RAC Audit Stoppage Not Likely to Affect Therapy ADR

February 20, 2014 2 Comments
RAC Audit Stoppage Not Likely to Affect Therapy ADR

CMS announced this week that the Recovery Audit program (RACs) would pause for a period of time so that the current ADR requests can process through the RAC reviews.  RAC audit stoppage is not likely to affect therapy ADRs.  In what might have been a false sense of “freedom” rehab providers reading RAC Monitor’s special […]

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Tricare Physical Therapist Assistant Not Allowed

February 13, 2014 43 Comments
Tricare Physical Therapist Assistant Not Allowed

Tricare does not reimburse for therapy provided by therapy assistants, and in fact excludes from reimbursement outpatient physical therapy that is performed by physical therapist assistants in the private practice setting (2/24/14 – clarified for private practice setting).  This may be a surprise to many providers, in that Tricare, like Medicare is a federal healthcare […]

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Appealing Medicare Denials – 5 Things You Must Know

February 11, 2014 0 Comments
Appealing Medicare Denials – 5 Things You Must Know

Appealing Medicare denials is likely to be a reality for all outpatient therapy providers this year. Therapy over the $3700 cap is subject to 100% mandatory medical review by the Recovery Auditors (RACs) through 3/31/2013.  In fact those reviews, if not favorable, will first frustrate you, then possible anger you, then compel you to file an […]

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ALJ Appellate Forum – What Therapy Providers Need to Know

February 8, 2014 4 Comments
ALJ Appellate Forum – What Therapy Providers Need to Know

The ALJ Appellate Forum on Wednesday, February 12th will be chock full of information that all outpatient therapy providers need to know.  If you have provided therapy over the $3700 caps (threshold) there is 100% RAC review of your claim(s).  Technically this is the OMHA Medicare Appellate Forum, but the provider industry has been quick […]

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Therapy $3700 Cap

February 6, 2014 0 Comments
Therapy $3700 Cap

The therapy $3700 cap (alternatively called threshold) is still in place for Medicare through 3/31/2014.  Claims over the therapy $3700 threshold will be reviewed by the Recovery Auditors (RACs) on either a prepayment or post-payment review basis.  Many providers use a quick estimate of $100 in Medicare allowable reimbursement per date of service, and then can […]

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Therapy PQRS Claims Measures

February 3, 2014 2 Comments
Therapy PQRS Claims Measures

Therapy PQRS claims measures for physical and occupational therapy have changed in 2014.  Now is the time for therapy clinics that have never reported to take the dip into the PQRS pool, if nothing else to stave off the 2% penalty reduction in 2016 for non-participation, or optimistically to gain a 0.5% bonus for accurately […]

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