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Tag: Medicare

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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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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Therapy Supervision

September 6, 2015 4 Comments
Therapy Supervision

Therapy supervision rules differ by venue in terms of Medicare, and may differ by state jurisdiction for Medicaid. Tricare does not have therapist supervision rules for private practice, as therapy assistants are not allowed by Tricare Military policy.  Medicare, Medicaid and Tricare supervision rules are payor rules.  There are also practice rules for supervision noted in your physical […]

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Physical Therapy Locum Tenens

September 4, 2015 0 Comments
Physical Therapy Locum Tenens

Physical therapy locum tenens is once again on the on the legislative “must do” list in 2015.  First, you may be wondering what does physical therapy locum tenens mean?  In short, if you are a physical (or occupational, or speech) therapist in a small private practice and you or one of your staff members takes […]

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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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