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Medicare Open Enrollment – Traditional Medicare & Medicare Advantage Options

October 6, 2013 0 Comments
Medicare Open Enrollment – Traditional Medicare & Medicare Advantage Options

Medicare open enrollment season is upon us.  No doubt when you are watching late night TV you are seeing all the ads from the likes of Humana and others targeting Medicare beneficiaries with the benefits of switching to a Medicare Advantage Plan (Medicare Part C).  Open enrollment starts October 15 and continues through December 7, […]

Outpatient Therapy While Beneficiary is Under Home Health Plan of Care

September 20, 2013 25 Comments
Outpatient Therapy While Beneficiary is Under Home Health Plan of Care

RAC ‘n Rehab© Series Does this sound familiar?  A patient comes into your outpatient therapy clinic and states they are not receiving any home health.  You are checking because you know if that the patient is receiving home health therapy, that they can’t also receive outpatient therapy, right?  STOP right there.  Even if a patient has […]

CMS Supplemental Review Contractor Targets Outpatient Therapy Stopped BeforeTherapy Caps

August 13, 2013 3 Comments
CMS Supplemental Review Contractor Targets Outpatient Therapy Stopped BeforeTherapy Caps

Outpatient therapy providers have been subject to CMS data mining and analysis to identify provision of therapy services that either stopped or delayed just under the therapy cap.  Over 350 therapy providers have received a letter from Strategic Health Solutions, a CMS Supplemental Review Contractor to submit selected claims for post payment review from the […]

Counting Outpatient Therapy Minutes – Medicare and More

August 12, 2013 3 Comments
Counting Outpatient Therapy Minutes – Medicare and More

Medicare constrains the number of units that can be billed in outpatient therapy based upon the number of minutes of therapy.  Based upon the time that is spent in providing therapy services that are performed in “timed” code treatment, the number of units that can be billed are defined in the Medicare 8 minute rule.  […]

Functional Limitation Reporting Requirements – Update from CMS

July 31, 2013 0 Comments
Functional Limitation Reporting Requirements – Update from CMS

CMS issued a MLN Matters Special Edition Article SE1307 to update functional limitation reporting requirements.  The issues date is 7/30/2013, the effective date is 7/2/2013.  Clarification was issued in the following areas (from the article): A reporting episode links a beneficiary to a specific therapy billing provier NPI.  In order to track beneficiary functional limitations, […]

Rehab Documentation Reviews and RACs: Who Ate My Fax?

July 18, 2013 3 Comments
Rehab Documentation Reviews and RACs: Who Ate My Fax?

Have your faxes not been getting through to the Recovery Auditors (RACs)?  You are in good company, and by the end of this post you’ll have a surefire way to securely get your records to the RAC.  RAC manual medical review of therapy claims over the $3700 thresholds are underway and providers are getting a […]

Documentation According to the OIG

July 16, 2013 0 Comments
Documentation According to the OIG

Has your therapy documentation been reviewed this year?  If you are participating in Medicare and your patient will exceed the $3700 threshold (PT and SLP combined, and a separate for OT) your documentation will be reviewed under the manual medical review program that is administrated by the Recovery Auditors (RACs).   The Office of the Inspector General […]

Jimmo v. Sebelius Settlement: – Will There Be More Opportunity for Continued Therapy?

July 12, 2013 0 Comments
Jimmo v. Sebelius Settlement: – Will There Be More Opportunity for Continued Therapy?

Therapists are beginning to question how the Jimmo vs. Sebelius (HHS/CMS) lawsuit might affect their therapy practice.  Therapists are thinking of those patients who make very small, and steady improvement, or patients who have chronic conditions that need therapy frequently in order to maintain independence. Or contemplating their patients residing in independent living apartment apartments whose ability to remain there (rather […]

Checking the OIG Excluded Individuals and Entities List – A Compliance Monitoring Mandate

July 11, 2013 0 Comments
Checking the OIG Excluded Individuals and Entities List – A Compliance Monitoring Mandate

The Office of Inspector General (OIG) released a new video to its array of social media educational offerings today on How to Use OIG’s Online Exclusions Database.  This new YouTube video supplements previous OIG training videos on exclusions and the use of the exclusions database.  If you are not using the Exclusions database, it is […]

OIG Adds Online Self-Disclosure Option

July 8, 2013 0 Comments
OIG Adds Online Self-Disclosure Option

The Office of the Inspector General (OIG)launched an online submission process for Provider Self-Disclosure Protocol. This now offers another submission method for providers who are  voluntarily disclosing self-discovered evidence of potential fraud to OIG. Self-disclosure gives providers the opportunity to avoid the costs and disruptions associated with a Government-directed investigation and civil or administrative litigation.  According […]