CMS suspended most audit activity this spring as a result of the Public Health Emergency (PHE). As the summer comes to an end, yet the PHE continues, CMS is signaling that it is getting back to the business of medical review. As Palmetto GBA has announced the return of post-payment audit reviews, other Medicare Administrative Contractors (MACs) have done so via their websites… Read More
Private Practice
There is No Therapy Cap
Yes, the Therapy Cap was eliminated! After 20 years of lobbying efforts by the therapy industry and other organization representing the interests of Medicare beneficiaries, Congress passed H.R.1892, The Bipartisan Budget Act of 2018. The elimination of the therapy cap was effective January 1, 2018. … Read More
Aquatic Therapy Compliance Community Pools
CMS allows therapy services to be furnished in a community pool by a clinician in a physical therapist or occupational therapist private practice, physician office, outpatient hospital, or outpatient SNF. For therapy services provided by those clinicians the community pool (all or part of it) must be rented or leased…. Read More
Aquatic Therapy Physical Therapy Compliance
Physical Therapists often look to the benefits of Aquatic Therapy (CPT® 97113) when implementing a Plan of Care. Medicare, as well as other Payers, have specific policies that dictate payment and coverage for Aquatic Therapy. Medicare guidance speaks to the provision of Aquatic Therapy by a Private Practice not only in the “clinic” … Read More
Who Can Establish a Plan of Care?
Outpatient therapy services furnished to a Medicare beneficiary by a therapy provider are payable only when furnished in accordance with certain conditions. Among the Conditions is the requirement that a Plan of Care for furnishing therapy services has been established by a physician/NPP or by the therapist providing therapy services…. Read More
Therapy TPE Audits Continue
Medicare Administrative Contractors (MAC) have quietly been reviewing therapy providers under the Targeted Probe and Education (TPE) program. The results of the reviews are posted by contracts, and provide general insight into topics, findings and implications. Novitas has completed … Read More
Compliance Consulting
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