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Tag: compliance

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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Aquatic Therapy Compliance

September 1, 2015 2 Comments
Aquatic Therapy Compliance

Does your facility offer aquatic therapy?  If so do you have aquatic therapy compliance addressed to ensure compliance with Medicare requirements for your type of Medicare enrollment?  Aquatic therapy may be offered at your facility, next door at the health club or a community pool such as the local YMCA.  Look to your Medicare Administrative […]

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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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$3700 Therapy Threshold RAC Reviews

December 4, 2014 1 Comment
$3700 Therapy Threshold RAC Reviews

$3700 therapy threshold RAC reviews have resumed even though the larger RAC program has been “paused”.  Therapy over the $3700 per beneficiary thresholds ($3700 for PT & SLP combined, another $3700 for OT) is mandatorily reviewed for medical necessity.  CMS has assigned the review task to the RACs.  According to information provided by CMS to the […]

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Keep Using 59 Modifier

November 25, 2014 1 Comment
Keep Using 59 Modifier

 CMS issued MM 8863 on Modifiers for Distinct Procedural Services in August leaving the therapy community wondering how to best use the new subset of the 59 modifier.  The subset, referred to as  X{EPSU}, was established to further define those “distinct  procedural services” identified as: XE – Separate Encounter XS – Separate Structure XP – Separate Practitioner XU […]

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Risky Business: Outsourcing SNF Therapy

October 26, 2014 1 Comment
Risky Business: Outsourcing SNF Therapy

Risky business in outsourcing SNF therapy you say?  A few weeks ago a news article was delivered to my inbox that might as well have been accompanied by alarm bells. Before you read the headline and consider yourself exempt, the startling aspect of the case is that it involves a SNF being held liable for […]

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Top 3 Essential Compliance Components

July 31, 2014 3 Comments
Top 3 Essential Compliance Components

Do you have the top 3 essential compliance components in your therapy program or practice?   You may have a compliance plan that you wrote, or purchased a compliance program off the shelf, or maybe your compliance program consists of chart audits and quality reviews.  The Office of the Inspector General (OIG) has provided Compliance Guidances […]

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Medical Record Corrections and Amendments

July 24, 2014 3 Comments
Medical Record Corrections and Amendments

Do you know how to make medical record corrections and amendments?  CMS refers to information that occurs following the visit documentation as “amendments”.  Did you ever finish a note only to discover several days later that you forgot to add something?  Whether on a paper and pencil system or electronic medical record system (EMR) there is specific guidance on […]

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