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Upcoming Audio Conferences
Posted 2012-01-29 04:01 PMGawenda Seminars and Consulting, Inc. will be presenting "Is Your Practice Profitable? Evaluating Practice Metrics, Part 1 and Part 2 on February 22, 2012 and March 21, 2012 respectively. This course is designed for the owner and/or administrator of a private practice or the director or manager of a facility based outpatient rehabilitation therapy department. Most owners, administrators, directors, and managers just look at the bottom line profitability of their practice/department to evaluate their business. A good owner/administrator/director/manager will take the next step and look at all the “other” indicators which provide feedback on the strengths and weaknesses of their financial situation. This course will go beyond looking at the profit and loss statement and show you how to use those numbers in establishing practice “metrics” or key indicators for your business. These numbers will be compared to national norms. In Part 2 we will present various models for evaluating clinician productivity and establishing incentive programs based on the practice metrics discussed in Part 1. We will also look at practice trends being implemented to lower costs and increase profitability.
For additional information and to register, click on the links below:
Is Your Practice Profitable? Evaluating Practice Metrics, Part 1
Is Your Practice Profitable? Evaluating Practice Metrics, Part 2
Congress Passes Legislation to Extend Therapy Cap
Posted 2012-02-18 06:02 AMOn February 17, 2012, the House of Representatives and Senate passed legislation that prevents the scheduled 27.4% reduction that was to go into effect on March 1, 2012 and extends the therapy cap through December 31, 2012.
Subscribe or Log In to view the whole articleCMS Revises Guideliness for Rehab Services in Hospitals
Posted 2012-02-18 06:02 AMThe Centers for Medicare and Medicaid Services (CMS) revised interpretative guidelines (Transmittal 72) to eliminate the requirement that rehabilitation services furnished in outpatient hospital settings be ordered by a practitioner with medical staff privileges. The new guidance issued to the State Survey Agency Directors on February 17, 2012 is effective immediately and includes the following language:
Subscribe or Log In to view the whole articleHHS Announces ICD-10 Delayed
Posted 2012-02-16 06:02 PMAs part of President Obama’s commitment to reducing regulatory burden, Health and Human Services Secretary Kathleen G. Sebelius announced on February 16 that the Department of Health and Human Services (HHS) will initiate a process to postpone the date by which certain health care entities have to comply with International Classification of Diseases, 10th Edition diagnosis and procedure codes (ICD-10).
Subscribe or Log In to view the whole articleICD-10 Possibly Delayed
Posted 2012-02-15 06:02 PMThe acting head of the CMS on February 14, 2012 signaled that the agency will extend the timeline on ICD-10 implementation. After speaking to attendees at the American Medical Association Advocacy Conference in Washington, acting CMS Administrator Marilyn Tavenner told reporters that the CMS will "re-examine the timeframe" through a rulemaking process. She did not say when that rulemaking process will begin but said the CMS would send details about the process in the coming days.
Subscribe or Log In to view the whole articlePalmetto Releases Revised PT and OT LCD
Posted 2012-02-13 09:02 PMPalmetto GBA, Medicare contractor for the states of California, Hawaii, and Nevada, released revised local coverage determinations (LCD) for outpatient physical and occupational therapy services for non-private practices.
Subscribe or Log In to view the whole articleRAC Prepayment Reviews Moving Forward
Posted 2012-02-13 05:02 PMOn November 15, 2011, the Centers for Medicare & Medicaid Services (CMS) announced the Prepayment Review and Prior Authorization for Power Mobility Devices (PMD) demonstration and the Recovery Audit Prepayment Review demonstration. The demonstrations were scheduled to begin on January 1, 2012. However, the CMS received many comments and suggestions regarding the demonstrations and the CMS is carefully considering these comments. Therefore, CMS delayed implementation of the two demonstrations. CMS has now announced that the demonstration projects are expected to move forward on or after June 1, 2012.
For updates on this and other demonstration projects, click HERE. For additional information on the Paper Reduction Act, click HERE.
Medicare Payments by EFT
Posted 2012-02-13 05:02 PMExisting regulations at 42 CFR 424.510(e)(1)(2) require that at the time of enrollment, enrollment change request, or revalidation, providers and suppliers that expect to receive payment from Medicare for services provided must also agree to receive Medicare payments through electronic funds transfer (EFT). Section 1104 of the Affordable Care Act further expands Section 1862(a) of the Social Security Act by mandating federal payments to providers and suppliers only by electronic means. As part of CMS's revalidation efforts, all suppliers and providers who are not currently receiving EFT payments are required to submit the CMS-588 EFT form with the Provider Enrollment Revalidation application, or at the time any change is being made to the provider enrollment record by the provider or supplier, or delegated official. For additional information on Medicare revalidation, click
Subscribe or Log In to view the whole articleNoridian Audits Aquatic Therapy
Posted 2012-02-13 05:02 PMNoridian Administrative Services (NAS) has completed a service specific review on the billing of aquatic therapy by hospitals in the states of Arizona and Utah and by critical access hospitals in Montana.
Subscribe or Log In to view the whole articleWPS In and NGS Out in Indiana & Michigan
Posted 2012-02-13 05:02 PMOn January 30, 2012, CMS notified National Government Services (NGS) that Wisconsin Physician Services (WPS) was confirmed as the awardee of the Medicare Administrative Contractor (MAC) Jurisdiction 8. This means that the CMS September 30, 2011 J8 award to WPS was upheld. WPS will serve as the MAC for the states of Indiana and Michigan and will process Medicare Part A and Part B claims for over 2.2 million Medicare beneficiaries. Additional information will be included in future updates as it becomes available.
Subscribe or Log In to view the whole articleNoridian Is J3 A/B MAC
Posted 2012-02-13 05:02 PMThe current J3 A/B MAC states of Arizona, Montana, North Dakota, South Dakota, Utah, and Wyoming along with Idaho Part B transitioned to the new J-F system on February 1, 2012. The current NAS Legacy states of Alaska, Idaho Part A, Oregon, and Washington will complete the transition to J-F on February 27, 2012. For additional information, click HERE.
Subscribe or Log In to view the whole articleTrailBlazer Health Releases Documentation Article
Posted 2012-02-13 05:02 PMTrailBlazer Health, Medicare contractor for Colorado, New Mexico, Oklahoma, and Texas, released an article on January 6, 2012 that addresses the medical necessity and documentation for outpatient therapy services.
Subscribe or Log In to view the whole article2012 Medicare Deductible Amount
Posted 2012-01-29 04:01 PMOn November 18, 2011, the Centers for Medicare and Medicaid Services released the update to Medicare deductible, co-insurance and deductible for 2012.
Subscribe or Log In to view the whole articleTransmittal 72
Posted 2012-01-29 04:01 PMCMS released Transmittal 72 on November 18, 2011 that revised conditions of participation and interpretative guidelines for hospitals. A main concern for outpatient therapy is the new requirement that physicians and non-physician practitioners (physician assistant, nurse practitioners, and clinical nurse specialists) who order outpatient therapy services have medical staff privileges at the hospital that the patient is attending outpatient therapy.
Subscribe or Log In to view the whole articleCMS Releases 2012 Final Rule for Services Reimbursed Under the MPFS
Posted 2012-01-07 05:01 PMOn November 1, 2011, the Centers for Medicare and Medicaid Services (CMS) released the 2012 final rule for services reimbursed under the Medicare Physician Fee Schedule (MPFS). Log in or subscribe for additional information and link.
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CMS Releases Proposed Rule
Posted 2012-01-07 05:01 PMCMS released a proposed rule today in the Federal Register titled "Medicare and Medicaid Program; Regulatory Provisions To Promote Program Efficiency, Transparency, and Burden Reduction". On page 8, CMS discusses the qualifications of PT's and OT's and making them consistent in the Medicaid program with the current qualifications in the Medicare program.
Subscribe or Log In to view the whole articleRevalidation of Medicare Enrollment
Posted 2012-01-07 05:01 PMProviders and suppliers who enrolled in the Medicare program prior to March 25, 2011 will have to revalidate their enrollment. Between now and March 23, 2013, your Medicare contractor will send out notices to begin the revalidation process for each provider and supplier. Providers and suppliers must wait to submit the revalidation until asked by your Medicare contractor.
Subscribe or Log In to view the whole articleCMS Releases IRF FY 2012 Final Rule
Posted 2012-01-07 05:01 PMThe Centers for Medicare and Medicaid Services released the IRF FY 2012 final rule on July 29, 2011. The final rule increases payment to IRF's by 2.2% and updates the case-mix group relative weights.
Subscribe or Log In to view the whole articleCMS Releases SNF FY 2012 Final Rule
Posted 2012-01-07 05:01 PMThe Centers for Medicare and Medicaid Services released the SNF FY 2012 final rule on July 29, 2011. The final rule will reduce payment to skilled nursing facilities by 11.1% in FY 2012 compared to FY 2011. This amounts to a projected savings of 3.87 billion dollars. The final rule contains several clarifications on issues important to the profession of therapy services including defining group therapy, revisions to student supervision policies, clarification on setting the date for the End of Therapy (EOT) Other Medicare Required Assessment (OMRA), and introduces a new Change of Therapy (COT) OMRA to capture those changes in a patient's therapy status that would be sufficient to affect the patient's RUG-IV classification and payment.
Subscribe or Log In to view the whole articleOffice of Inspector General Releases SNF FY 2011 Report
Posted 2012-01-07 05:01 PMThe Office of the Inspector General (OIG) released a report on July 8, 2011 detailing the payment made to SNF's in the first half of FY 2011 compared to the last half of FY 2010. The OIG found that Medicare payments increased by $2.1 billion or 16% in the first half of FY 2011 compared to the last half of FY 2010. For further information and to read the recommendations the OIG is making to the Centers for Medicare and Medicaid Services, please log in.
Subscribe or Log In to view the whole articleAdvance Beneficiary Booklet Revised
Posted 2012-01-07 05:01 PMThe Medicare Learning Network has released an updated version of the Advance Beneficiary Notice of Non-Coverage for Part A and B services booklet. The booklet was published in April 2011 and was current at the time of release. Please read the disclaimer on the first page. To access the booklet, subscribers must log in.
Subscribe or Log In to view the whole articleMedicare Billing for SLP's in Private Practice
Posted 2012-01-07 05:01 PMThe Medicare Learning Network (MLN) has updated their fact sheet for Medicare billing for speech language pathologists in private practice. To access the fact sheet, subscribers must log in.
Subscribe or Log In to view the whole articleAetna to Apply MPPR to Certain Therapy Procedures
Posted 2012-01-07 05:01 PMIn their June 2011 Aetna OfficeLinks Updates, Aetna announced they would begin applying the multiple procedural payment reductions to certain therapy codes effective November 14, 2011. It is unclear at this time if Aetna will apply the MPPR policy the same as the Medicare program does, in a cascading format, or some other format. For the reference, please log in and click on the link below and choose your region based on the state you practice in.
Subscribe or Log In to view the whole articleMultiple Procedure Payment Reduction (MPPR) Policy
Posted 2012-01-07 05:01 PMThe Centers for Medicare and Medicaid Services has issued a Medicare Learning Network Matters bulletin regarding the MPPR policy that went into effect January 1, 2011. Subscribers log in for additional information.
Subscribe or Log In to view the whole articleCMS Releases 2011 Medicare Physician Fee Schedule Conversion Factor
Posted 2012-01-07 05:01 PMCMS has released the 2011 Medicare Physician Fee Schedule (MPFS)Conversion Factor. In 2011, the conversion factor will be 33.9764. This is a 7.9% decrease from 2010. To access the transmittal, click on the link below. If you are an APTA member, APTA has published the 2011 Medicare Physician Fee Schedule Calculator on their website. Providers can choose from the 20% or 25% reduction based on their practice setting. To access the APTA website for the MPFS calculator, subscribers must log in.
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Medicare Cuts Avoided for 2011/Therapy Cap Exception Process Extended
Posted 2012-01-07 05:01 PMPresident Obama signed into law the Medicare & Medicaid Extenders Act of 2010. This law averts the scheduled 25.5% reduction in payment to providers of outpatient therapy services and extends the current payment rate through December 31, 2011. The law also extends the therapy cap exception process through December 31, 2011, and repeals the delay of the implementation of RUG IV for SNF's Part A .The law did not address the MPPR policy that will reduce payments by approximately 4%-8% in 2011.
Subscribe or Log In to view the whole articleMedicare Cuts Avoided
Posted 2012-01-07 05:01 PMCongress passed and President Obama signed into law on November 30, 2010 The Physician Payment and Therapy Relief Act of 2010. The law stops the scheduled 23.2% reduction that was supposed to go into effect on December 1, 2010 and allows providers to be paid at the current rate through the rest of this year. The law also reduces the Multiple Procedure Payment Reduction Policy from 25% to 20%. Further congressional action is required to stop the scheduled 25.5.% payment reduction that begins Janaury 1, 2011.
Subscribe or Log In to view the whole articleCMS Releases 2011 Medicare Physician Fee Schedule Final Rule
Posted 2012-01-07 05:01 PMCMS has released the final rule for 2011 for services reimbursed under the Medicare Physician Fee Schedule. The proposed Multiple Procedure Payment Reduction of 50% to the practice expense of the second and all subsequent units billed on the same day was reduced from 50% to 25% that will have an approximate 7-9% reduction in payment to providers, dependent on their practice setting. This percent will be offset by gains elsewhere; however, CMS estimates it will have a negative 5% on providers of outpatient therapy services. Subscribers log in for additional information and link to the final rule.
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ICD-9 Codes - October 1, 2010 Changes
Posted 2012-01-07 05:01 PMCMS has posted new, revised, and deleted ICD-9 codes effective October 1, 2010 on their website. SLP's and OT's have several new ICD-9 codes that may be of benefit to them in accurately coding their treatment/therapy/impairment diagnosis to the insurance carrier. Log in for additional information and link.
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Signature Guidelines for Medical Review Purposes
Posted 2012-01-07 05:01 PMCMS has issued additional guidance on signature requirements when medical records are being reviewed by Medicare contractors, RAC's, or the Comprehensive Error Rate Testing contractors. To review the guidelines, subscribers must log in.
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Medicare Physician Fee Schedule Update
Posted 2012-01-07 05:01 PMIntroductory text sampleSubscribe or Log In to view the whole articleHealth Care Reform Becomes Law
Posted 2012-01-07 05:01 PMIntroductory text sampleSubscribe or Log In to view the whole articleChanges to the Medicare Appeals Process
Posted 2012-01-07 05:01 PMCMS released the final rule for changes in the Medicare appeals process on December 9, 2009 in the Federal Register.
Subscribe or Log In to view the whole articleCMS Releases Final Rule for Services Reimbursed under the MPFS
Posted 2012-01-07 05:01 PMThe Centers for Medicare and Medicaid Services released the final rule for services reimbursed under the Medicare Physician Fee Schedule on October 30, 2009.
Subscribe or Log In to view the whole articleCMS Releases SNF Part A 2010 Final Rule
Posted 2012-01-07 05:01 PMIntroductory text sampleSubscribe or Log In to view the whole articleCMS Releases IRF FY 2010 Final Rule
Posted 2012-01-07 05:01 PMIntroductory text sampleSubscribe or Log In to view the whole articleCMS Issues Updated Appeals Process Information
Posted 2012-01-07 05:01 PMIntroductory text sampleSubscribe or Log In to view the whole articleCMS Seeking Comments on Proposed IRF Revisions
Posted 2012-01-07 05:01 PMIntroductory text sampleSubscribe or Log In to view the whole articleCMS to Reimburse for Canalith Repositioning
Posted 2012-01-07 05:01 PMIntroductory text sampleSubscribe or Log In to view the whole articleCMS Releases 2009 Medicare Physician Fee Schedule Final Rule
Posted 2012-01-07 05:01 PMIntroductory text sampleSubscribe or Log In to view the whole articleCMS Announces RAC Medical Record Request Limits
Posted 2012-01-07 05:01 PMIntroductory text sampleSubscribe or Log In to view the whole articleCMS Awards Four RAC Contracts & Announces Contingency Fees
Posted 2012-01-07 05:01 PMIntroductory text sampleSubscribe or Log In to view the whole articleCMS Releases Transmittal 88
Posted 2012-01-07 05:01 PMThe Centers for Medicare & Medicaid Services released Transmittal 88 on May 7, 2008. This transmittal includes many important changes and clarifications to outpatient therapy services provided by physical therapists, occupational therapists, and speech-language pathologists.
Subscribe or Log In to view the whole articleCMS RELEASES UPDATE ON OUTPATIENT THERAPY CAPS EXCEPTION PROCESS
Posted 2012-01-07 05:01 PMThe Centers for Medicare & Medicaid Services (CMS) issued Transmittal 1414 on January 17, 2008 adjusting the dollar amount for the therapy cap for 2008 along with clarifications to the manual concerning exceptions to outpatient therapy services.
Subscribe or Log In to view the whole articleCMS RELEASES DRAFT FINAL VERSION OF MDS 3.0
Posted 2012-01-07 05:01 PMThe Centers for Medicare & Medicaid Services released the draft final version of MDS 3.0 on January 15, 2008 along with the draft final MDS 3.0 introduction.Log in to access additional information.
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CONGRESS PASSES THE MEDICARE, MEDICAID AND SCHIP EXTENSION ACT OF 2007
Posted 2012-01-07 05:01 PMCongress has approved legislation postponing the Medicare therapy cap and scheduled cuts to the physician fee schedule. Lawmakers on Wednesday sent to the president legislation extending the therapy cap exceptions process and implementing a 0.5% positive update in the fee-schedule conversion factor until June 30, 2008. President Bush is expected to sign this legislation into law.Subscribe or Log In to view the whole articleCMS Releases 2008 Medicare Physicain Fee Schedule Final Rule
Posted 2012-01-07 05:01 PMThe Centers for Medicare & Medicaid Services (CMS) releaed the final rule for services reimbursed under the Medicare Physician Fee Schedule on November 1, 2007 and it was published in the Federal Register on November 27, 2007.
Subscribe or Log In to view the whole articleCMS Releases Fiscal Year 2008 IRF Final Rule
Posted 2012-01-07 05:01 PMThe Centers for Medicare & Medicaid Services released the fiscal year 2008 IRF final rule in the Federal Register on August 7, 2007. The effective date is October 1, 2007.Subscribe or Log In to view the whole articleCMS Releases Transmittal Regarding Charging for Missed Appointments
Posted 2012-01-07 05:01 PMThe Centers for Medicare & Medicaid Services released Transmittal 1279 on June 29, 2007 clarifying that they do not prohibit physicians, suppliers, and hospitals for charging Medicare patient's for missed appointments as long as they do not discriminate against Medicare beneficiaries and also charge non-Medicare patient's for missed appointments. Effective date is October 1, 2007.
Subscribe or Log In to view the whole articleCMS Releases Transmittal Clarifying Therapy Evaluations in SNF Setting
Posted 2012-01-07 05:01 PMThe Centers for Medicare & Medicaid Services released Transmittal 73 on June 29, 2007 clarifying that a PT, OT, and/or SLP evaluation must be performed during the beneficiary's stay in the SNF setting.
Subscribe or Log In to view the whole articleCMS rescinds Transmittal 65
Posted 2012-01-07 05:01 PMThe Centers for Medicare & Medicaid Services has rescinded Transmittal 65 concerning the application of the outpatient documentation requirements to the inpatient setting and defining who are qualified professionals to provide and bill for therapy services.
Subscribe or Log In to view the whole articleCMS Issues Infrared Decision Memo
Posted 2012-01-07 05:01 PMCMS released Transmittal 1127 and Transmittal 62 on December 15, 2006 providing further information on Infrared devices that supplements the national coverage decision that went into effect on October 24, 2006. Transmittal 1127 was rescinded and replaced by Transmittal 1183 on February 9, 2007. This new Transmittal provides ICD-9 codes that do not support the medical necessity of infrared devices. Subscribe or Log In to view the whole articleCMS Releases Information On Therapy Cap Exception Process
Posted 2012-01-07 04:01 PMThe Centers for Medicare & Medicaid Services released 3 transmittals on February 13, 2006 outlining the therapy cap exception process. The first transmittal contains information that will be included in the Medicare Benefit Policy Manual, Chapter 15. The second transmittal contains information that will be included in the Medicare Program Integrity Manual, Chapter 3. The third transmittal contains information that will be included in the Medicare Claims Processing Manual, Chapter 5. The exception process must be implemented no later than March 13, 2006. Log in to view the transmittals.
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CCI Edits To Apply To Rehab Agencies, SNF Part B, CORF\'s, and HHA\'s
Posted 2012-01-07 04:01 PMEffective January 1, 2006, the Medicare CCI edits will be applied to Rehab Agencies, Skilled Nursing Facilities (SNF) providing outpatient therapy under Medicare Part B, Comprehensive Outpatient Rehabilitation Facilities (CORF), and Home Health Agencies (HHA) providing home health services not under a home health plan of treatment. Currently, the CCI edits are only being applied to rehabilitation therapy services provided by physical and occupational therapists in private practice, physician owned physical and occupational therapy practices, and in hospital outpatient departments. This is not applicable to Critical Access Hospitals. Subscribe or Log In to view the whole article
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