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Tag: CMS

New Physical Therapy Codes for 2017

July 8, 2016 8 Comments
New Physical Therapy Codes for 2017

New physical therapy codes for 2017 were released yesterday by CMS as part of the Medicare Physician Fee Schedule Proposed Rule for 2017 (CMS-1654-P).  The therapy community has long awaiting the anticipated changes to the current CPT coding structure.  The proposed rule provides information on the new physical therapy and occupational therapy evaluation codes (we […]

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Therapy Manual Medical Review Again

July 5, 2016 2 Comments
Therapy Manual Medical Review Again

Here we go again!  Therapy manual medical review again! Just when the therapy community, particularly those in private practice, were thinking that CMS forgot about manual medical review of outpatient therapy over $3700 CMS opted a stealth move, the though an update to the therapy cap website.  It represents a long-awaited announcement, but not a particularly welcome […]

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2016 PQRS Measures for Occupational Therapy

January 3, 2016 0 Comments
2016 PQRS Measures for Occupational Therapy

There is no change in 2016 PQRS measures reporting for occupational therapy for claims based reporting.  As the new year begins occupational therapists, much like physical therapists, may find themselves in one of three situations regarding PQRS reporting:  1) Successful reporting in 2014, and therefore no reductions to Medicare payments in 2016. 2) Notification that 2014 reporting […]

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2016 PQRS Measures for Physical Therapy

January 1, 2016 1 Comment
2016 PQRS Measures for Physical Therapy

Time to get started to with 2016 PQRS measures for physical therapy!  As the new year begins physical therapists may find themselves in one of three situations regarding PQRS reporting:  1) Successful reporting in 2014, and therefore no reductions to Medicare payments in 2016. 2) Notification that 2014 reporting was unsuccessful and therefore a 2% […]

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Medicare Therapy Cap in 2016

November 25, 2015 2 Comments
Medicare Therapy Cap in 2016

The Medicare therapy cap in 2016 is set at $1960.  The therapy cap for physical and speech-language pathology combined is set at $1960 and there is a separate $1960 therapy cap for occupational therapy.   This represents an increase of $20 per cap over the 2015 amount of $1940.  The increment is based upon a medical […]

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Does Medicare Cover Ionto?

September 12, 2015 0 Comments
Does Medicare Cover Ionto?

Therapists always seem to ask “does Medicare cover ionto?”  There is a bit of urban legend that Medicare does not cover this constant attendance modality, where in fact there is not a National Coverage Determination (NCD) that speaks to the use of ionto. According to the clinical responsibility description of iontophoresis at SuperCoder: Iontophorehis (Ionto) is […]

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What is A Rehab Agency?

September 11, 2015 0 Comments
What is A Rehab Agency?

I get calls and inquiries asking “what is a rehab agency”.  Generally people have heard that a rehab agency may be a more profitable outpatient model than private practice, or that supervision rules for assistants are more favorable.  Some outpatient providers have been told by managed care payors that certification as a rehab agency or CORF […]

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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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