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Archive for March, 2014

Functional Limitation Reporting: More Claims Problems

March 19, 2014 4 Comments
Functional Limitation Reporting: More Claims Problems

Functional limitation reporting: more claims problems are being officially reported today – Wednesday, March 19, 2014.   When will it stop? The better question is when will it be resolved?  In a recent post  on functional limitation reporting, I discussed problems that were reported in the common working file that are scheduled to be corrected on Monday, March […]

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Tricare and Private Practice PTAs

March 18, 2014 14 Comments
Tricare and Private Practice PTAs

Tricare policy does not allow for therapy to be paid when it is provided by a physical therapist assistant (PTA) in private practice settings.  A previous post on this generated a lot of comments , as well as a lot of email.  The reference in that post on Tricare and private practice PTAs was the […]

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Medicaid Exclusion Checks

March 17, 2014 2 Comments
Medicaid Exclusion Checks

CMS issued a State Medicaid Director Letter (SMDL)  in 2009 recommending that States require providers to screen all employees and contractors monthly.  However in 2011, CMS issued final regulations mandating States to screen all enrolled providers monthly.   Furthermore Section 6501 of PPACA requires States to terminate individuals or entities from their Medicaid programs if the individuals […]

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Importance of Checking Exclusions

March 16, 2014 2 Comments
Importance of Checking Exclusions

Checking exclusions is a key component of any viable compliance program.  The Office of the Inspector General (OIG) of the US Department of Health and Human Services maintains a list of excluded individuals and entities (LEIE).   Anyone who hires an individual or entity named on the LEIE may be subject to civil monetary penalties (CMP).  […]

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Functional Limitation Reporting Claim Rejections

March 13, 2014 8 Comments
Functional Limitation Reporting Claim Rejections

Will it ever stop?  The problems with functional limitation reporting claim rejections that is.  Grant it, there are some confusing scenarios that create provider side problems in coding, but the bigger issue is the continued problems with CMS and the Medicare Administrative Contractors adjudicating claims.  Because of the difference in reporting and adjudication for those reporting on the […]

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Writing Functional Therapy Goals

March 11, 2014 9 Comments
Writing Functional Therapy Goals

Are you writing functional therapy goals?  I guess I better take that a step back and ask if you are accurately writing functional therapy goals for a Medicare Plan of Care.   Required elements of the Medicare Plan of care include 1) Diagnoses; 2) Long term treatment goals, and 3) Type, amount, duration and frequency of therapy […]

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Therapy PQRS Panic

March 6, 2014 1 Comment
Therapy PQRS Panic

It seems like therapy PQRS panic is setting in, and setting in fast.  I am hearing from practices from Minnesota to California to Florida and parts in between.  Most folks that are in contact with me have heard me speak at a webinar or perhaps have read my blog posts on PQRS over the past month […]

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Rehab Compliance Confidential

March 5, 2014 0 Comments
Rehab Compliance Confidential

Problems come up all the time in the therapy world and people look to their peers for help, support and resources, whether at hospitals, private practice, nursing home or home health agencies.  It is fantastic to be able to look to peers when you are seeking advice on a Medicare policy (does Medicare pay for aquatic […]

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Therapy Medicare Documentation Requirements

March 4, 2014 2 Comments
Therapy Medicare Documentation Requirements

Do you know therapy Medicare documentation requirements?  Take a minute before you answer.  While you are thinking about your answer, here are some more teasers: do you have a copy of your Medicare Administrative Contractor’s (MAC) local coverage determination, (LCD) and is it current?  Do you know the required and voluntary elements of the therapy […]

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Functional Limitation Reporting Trouble With Unplanned Discharges

March 3, 2014 2 Comments
Functional Limitation Reporting Trouble With Unplanned Discharges

Trouble, trouble I say in River City, that is trouble everywhere you look with functional limitation reporting and unplanned discharges.  Not quite the problem that Professor Harold Hill faced, but let’s sing along with a chorus of  “76 Trombones”. In a nice neat world, all patients continue with therapy until their planned discharge, and there […]

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