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Archive for August, 2015

Wheelchair Assessment

August 31, 2015 1 Comment
Wheelchair Assessment

Are you being asked to provide a wheelchair assessment?  Physicians referring a patient for a wheelchair are required by Medicare, Medicaid other payers to follow guidelines for submitting a prescription and letter of medical necessity. Physicians seek the expertise of physical and occupational therapists in completing the necessary paperwork they must submit in support of the wheelchair request. Therapy […]

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Compliance Plan Seven Elements

August 30, 2015 1 Comment
Compliance Plan Seven Elements

 A compliance plan should address seven elements that are based upon the Federal Sentencing Guidelines.  TheOffice of Inspector General has developed numerous compliance guidances over the past 17 years.  For outpatient therapy practices the OIG’s Compliance Program Guidance for Individual and Small Group Physician Practices (published in the Federal Register: Vol. 65, No. 194 / Thursday, […]

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New Rules for Therapy Appeals

August 29, 2015 1 Comment
New Rules for Therapy Appeals

CMS has issued guidance for reviews at the redetermination and reconsideration levels resulting in new rules applicable for therapy appeals.  Given that providers are now receiving the results of manual medical review of therapy over the $3700 threshold therapy providers have an interest in appealing unfavorable decisions, particularly for institutional providers billing on the UB04 claim […]

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Therapy Direct Access and Medicare

August 27, 2015 1 Comment
Therapy Direct Access and Medicare

How does  therapy direct access and Medicare get along?  Therapists with direct access are often discouraged to learn that the freedom to practice without physician referral may come at a cost of insurance reimbursement, including Medicare.  Does a Medicare beneficiary need a physician referral for physical or occupational therapy?  Well it depends on if the […]

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Medicare Signature Requirements – Update

August 26, 2015 1 Comment
Medicare Signature Requirements – Update

Medicare recently updated signature requirements in Transmittal 604 to the Medicare Program Integrity Manual.    The updates include the inclusion of the Supplemental Medical Review Contractor (SMRC) to the list of contractors (MACs, ZPICs, CERT) bound by the policy that we reviewed in a previous post. Many providers may remember that the current SMRC is Strategic […]

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