Manual Medical Review
How do I submit a request for manual medical review in 2013?
In 2013 the Manual Medical Review process is continuing, but there is no longer an option to receive prior authorization for visits. All therapy over the $3700 threshold will be subject to manual medical review. Effective for claims received through March 31st, the Medicare Administrative Contractor (MAC) will conduct prepayment review and notify the provider of the results. On April 1st the Recovery Auditors (RACs) took over the manual medical review process. Prepayment reviews will be conducted in the 11 states currently in the RAC Pre-Payment Demonstration program. Providers in the remaining 39 states will have their claims paid, but post-payment review will automatically commence.
Functional Limitation Reporting
When does functional limitation reporting of G codes being?
CMS has required functional limitation reporting for all Part B therapy services effective January 1, 2013. Though June 30th there is a testing period in order for providers to ensure that they have appropriate systems in place to properly complete functional limitation reporting of G codes and the requisite modifiers. Effective July 1, 2013, claims that do no contain the required functional limitation reporting and modifiers will be rejected.
Comprehensive Outpatient Rehabilitation Facilities (CORFs)
Must the physician write the plan of care in a CORF?
A physician must write the plan of care in a CORF for respiratory therapy services. Additionally the certifying physician must have expertise in pulmonary rehabilitation. In all CORF therapy services, therapy may not begin until the physician has certified (signed) the plan of care. This regulation applies to physical therapy, occupational therapy and speech-language pathology plans of care in addition to respiratory therapy plans of care.