Jul 29, 2021 |
Beginning August 17, 2020, CMS directed the MACs to resume fee-for-service medical review activities beginning with post payment reviews of items/services provided before March 1, 2020. Items and services are selected based upon high error rates and/or potential overutilization identified through data analysis. Physical Therapy/Occupational Therapy: CPT Codes 97110, 97112, 97140, 97530 The goal of CGS’s Medical Review (MR) program is to reduce errors through claims reviews and education on Medicare’s coverage, coding, payment and billing policies. To achieve this goal, we conduct data analysis to identify provider billing services of CPT/HCPCS codes that pose the greatest risk to the Medicare program. The reviews involve providers billing CPT codes 97110 (Therapeutic exercises), 97112 (Neuromuscular reeducation), 97140 (Manual therapy techniques), and 97530 (Therapeutic activities.) Documentation will be reviewed for compliance with Medicare rules and regulations such as: medical necessity; required components and signatures; deliverance of the service; as well as correct coding and billing per medical necessity. ...
May 25, 2021 |
On May 16, 2021 the CDC released their latest guidelines regarding COVID-19 mask requirements. In addition to these guidelines, please remember to follow your State guidelines as well. You may access the complete notice HERE. If you are fully vaccinated, you can resume activities that you did prior to the pandemic. Fully vaccinated people can resume activities without wearing a mask or physically distancing, except where required by federal, state, local, tribal, or territorial laws, rules, and regulations, including local business and workplace guidance. If you haven’t been vaccinated yet, find a vaccine....
Apr 20, 2021 |
On April 15, 2021, Xavier Becerra, Secretary of Health and Human Services, renewed the Public Health Emergency (PHE) due to COVID-19. The PHE will now end at the end of the day on July 19, 2021. This extension will also extend approval of outpatient telehealth for Medicare until July 19,...
Apr 19, 2021 |
This legislation was introduced during the last session of Congress; an amended version of the bill was signed into law on Dec. 27, 2020. The No Surprises Act establishes federal standards to protect patients from balance billing during emergency services for defined items and services provided by specified doctors, hospitals, and air ambulance carriers on an out-of-network basis. The federal law applies to individual, small group, and large group fully insured markets and self-insured group plans including grandfathered plans. The law applies to emergency services at out-of-network (OON) hospitals and free-standing emergency facilities, OON providers at in-network facilities, and OON air ambulance carriers. The No Surprises Act applies to three types of health care providers and facilities: Out-of-Network emergency covered items and services. Covered medical items and services performed by an out-of-network provider at an in-network hospital or emergency facility. Example: an out-of-network anesthesiologist providing services at an in-network hospital. Out-of-network air ambulance items and services. The bill also prohibits out-of-network providers of ancillary services at an in-network facility from balance billing members. Ancillary services are defined by the No Surprises Act as those related to emergency medicine, anesthesiology, pathology, radiology, neonatology, and laboratory. The original legislation (as introduced) did contain language that APTA opposed that would have also added a mandated disclosure to patients in writing on estimates for prices of services that could have been interpreted as applying to additional providers and settings such as outpatient physical therapy clinics. The version signed into law removed that problematic section of the legislation. ...
Apr 19, 2021 |
The Physical Therapy Compact is an agreement between member states to improve access to physical therapy services for the public by increasing the mobility of eligible physical therapy providers to work in multiple states. The Physical Therapy Compact Commission is the governing body comprised of the member states established to implement the provisions of the PT Compact. Member States The following map provides the current status of the Compact. PT Compact Commission Delegates The PT Board in each member state selects a delegate to the PT Compact Commission. The delegate must be a current member of the PT Board and one of the following: physical therapist physical therapist assistant public member board administrator PT Compact Commission Executive Board The PT Compact Commission elects the seven-member Executive Board from the Compact Commission Delegates to represent the member states as a whole. In addition, representatives from the American Physical Therapy Association (APTA) and the Federation of State Boards of Physical Therapy (FSBPT) serve as non-voting ex-officio members....
Apr 19, 2021 |
By Delegates Westfall, Summers, Jennings, Tully, Bates and L. Pack [Introduced March 03, 2021; Referred to the Committee on Health and Human Resources] A BILL to amend and reenact §30-3F-1, §30-3F-2, and §30-3F-3 of the Code of West Virginia, 1931, as amended, relating to expanding direct primary care arrangements to include other directed health care arrangements. Be it enacted by the Legislature of West Virginia: ARTICLE 3F. DIRECT PRIMARY MEDICAL CARE. §30-3F-1. Definitions. As used in this section: (1) “Boards” means the West Virginia Board of Medicine; the West Virginia Board of Osteopathic Medicine, the West Virginia Board of Optometry, West Virginia Board of Physical Therapy, West Virginia Board of Chiropractic, West Virginia Board of Dentistry and the West Virginia Board of Examiners for Registered Professional Nurses; (2) “Direct primary medical care membership agreement” means a written contractual agreement between a primary care provider and a person, or the person’s legal representative; (3) “Direct primary medical care provider” means an individual or legal entity, alone or with others professionally associated with the provider or other legal entity, that is authorized to provide primary medical care services and who chooses to enter into a direct primary medical care membership agreement; (4) “Medical products” means any product used to diagnose or manage a disease, including any medical device, treatment or drug; (5) “Medical services” means a screen, assessment, diagnosis or treatment for the purpose of promotion of health or the detection and management of disease or injury within the competency and training of the direct primary medical care provider; and (6) “Primary Medical care provider” means an individual or other legal entity that is authorized to provide medical services and medical products under his or her scope of practice in this state. §30-3F-2. Direct Primary Medical Care....
Apr 19, 2021 |
The Coronavirus Aid, Relief, and Economic Security (CARES) Act suspended the sequestration payment adjustment percentage of 2% applied to all Medicare Fee-for-Service (FFS) claims from May 1 through December 31, 2020. The Consolidated Appropriations Act, 2021, extended the suspension period to March 31, 2021. An Act to Prevent Across-the-Board Direct Spending Cuts, and for Other Purposes, signed into law on April 14, 2021, extends the suspension period to December 31, 2021. Medicare Administrative Contractors will: Release any previously held claims with dates of service on or after April 1 Reprocess any claims paid with the reduction applied You don’t need to take any action. ...
Apr 19, 2021 |
Informed consent is an essential aspect of ethical patient care. But what does the term really mean in practical terms? And what are physical therapists’ and physical therapist assistants’ obligations for obtaining informed consent from patients? This column provides some answers. Key Principles Two core principles underlie informed consent: patient autonomy and shared communication and decision-making between the patient and provider. The American Medical Association’s Code of Medical Ethics states: Patients have the right to receive information and ask questions about recommended treatments so that they can make well-considered decisions about care. Successful communication in the patient-physician relationship fosters trust and supports shared decision making. The process of informed consent occurs when communication between a patient and physician results in the patient’s authorization or agreement to undergo a specific medical intervention. For patients to make what AMA calls a “well-considered” choice about their treatment, they must know what the proposed treatment promises, any associated risks, and the benefits and risks of the alternatives. What Constitutes Informed Consent in Physical Therapy? The APTA Guide for Professional Conduct, which provides interpretation for the APTA Code of Ethics for the Physical Therapist, does not use the phrase “informed consent.” It does say that a PT must “respect the individual’s right to make decisions regarding the recommended plan of care, including consent, modification, or refusal.” The APTA Code of Ethics states that PTs must “provide the information necessary to allow patients or their surrogates to make informed decisions about physical therapy care” and “collaborate with patients and clients to empower them in decisions about their health care.” But the APTA Guide for Professional...
Apr 19, 2021 |
Temporary Claims Hold Pending Congressional Action to Extend 2% Sequester Reduction Suspension In anticipation of possible Congressional action to extend the 2% sequester reduction suspension, we instructed the Medicare Administrative Contractors (MACs) to hold all claims with dates of service on or after April 1, 2021, for a short period without affecting providers’ cash flow. This will minimize the volume of claims the MACs must reprocess if Congress extends the suspension; the MACs will automatically reprocess any claims paid with the reduction applied if necessary....
Apr 19, 2021 |
Time is up on the moratorium on recoupment for funds received through the Accelerated & Advance Payment program Did you take advantage of the U.S. Center for Medicare & Medicaid Services’ COVID-19 Accelerated & Advance Payment program? CMS says it’s time to begin settling up. The agency recently announced that the 12-month delay on recoupment for money issued through the CAAP is drawing to a close. Beginning at one year from the date the payment was issued, providers and suppliers who opted for the program can expect a 25% “recoupment” — essentially a 25% reduction in payments owed from Medicare for 11 months, followed by a 50% recoupment for the next six months, if any money is still owed. The CAAP program was expanded in late March 2020, in order to offer loans to qualified providers affected by the COVID-19 pandemic. By late April, CMS began suspending elements of the program in light of money disbursed through the CARES Act Provider Relief Fund. CMS also outlined how it will approach money still owed after the 17-month recoupment phase: After issuing a demand letter, CMS will consider the remaining balance an overpayment and be subject to a 4% interest rate “along with all normal recovery activities.” Providers experiencing financial hardship may be able to qualify for an extended repayment schedule. More information on the recoupment process is available on the CMS CAAP frequently asked questions webpage and via this CMS fact sheet on repayment terms. Questions can be directed to your Medicare Administrative...
Apr 19, 2021 |
In response to feedback from health care professionals, Optum Pay now includes additional payment information that you can access at no cost. Specifically: Detailed remittance information (downloadable PDFs), as well as access to 835 files for each payment processed through Optum Pay Access up to 13 months of payment data This change recognizes the importance of having downloadable provider remittance advice (PRA) documents available to help with your financial management and claim reconciliation activities. Note: Optum Pay basic is only available to health care professionals and facilities who enroll in Automated Clearing House (ACH)/direct deposit through Optum Pay. Option to update your Optum Pay premium enrollment If you were enrolled in Optum Pay premium during the recent free trial period, you can cancel your enrollment through the end of March without penalty. This means you won’t be charged the $0.5% per payment fee for any claim payments. If you would like to cancel your premium-level access, be sure to follow these steps: Fill out the cancellation form opens in a new window Email the completed form to optumpay_cancel@optum.com Please note: Cancellations are effective on the date the form is received by Optum Pay. You won’t be charged for any additional days needed to process your request. Resources Find updated information on Optum PayOpens in a new window Call the Help Center at 877-620-6194 or email optumpay@optum.com Access Document Vault and the new UnitedHealthcare Provider Portal. These are alternative solutions for some plans and available to health care professionals at no charge. ...
Apr 19, 2021 |
Notification of Service Specific Post Payment Review for Physical Therapy/Occupational Therapy: CPT Codes 97110, 97112, 97140, 97530 Beginning August 17, 2020, CMS directed the MACs to resume fee-for-service medical review activities beginning with post payment reviews of items/services provided before March 1, 2020. Items and services are selected based upon high error rates and/or potential overutilization identified through data analysis. The goal of CGS’s Medical Review (MR) program is to reduce errors through claims reviews and education on Medicare’s coverage, coding, payment and billing policies. To achieve this goal, we conduct data analysis to identify provider billing services of CPT/HCPCS codes that pose the greatest risk to the Medicare program. The reviews involve providers billing CPT codes 97110 (Therapeutic exercises), 97112 (Neuromuscular reeducation), 97140 (Manual therapy techniques), and 97530 (Therapeutic activities.) Documentation will be reviewed for compliance with Medicare rules and regulations such as: medical necessity; required components and signatures; deliverance of the service; as well as correct coding and billing per medical necessity. Additional Documentation Request (ADR) letters will be sent. Please submit requested documentation within 45 days of receipt of the ADR letter. Please include a copy of your ADR letter and claim cover sheet with each claim documentation submission. Failure to respond by the 45th day will result in denial for non-response and recoupment of dollars paid in error. Documentation Necessary to Process the Claim We expect all documentation submitted with each ADR letter to be legible and include a copy of the following from each patient’s medical record: Beneficiary’s name Date of service (DOS) Initial Order for therapy from ordering provider if DOS reviewed is...
Jan 6, 2021 |
Tuesday January 19 at Noon Be sure to register to learn more about this new member benefit program you are invited to join. This program will be conducted in confidential small groups. Please join us to learn valuable tips to grow your...
Jan 6, 2021 |
MIPS Eligible Clinicians Can Start Submitting Data for 2020 through March 31 CMS has opened the data submission period for Merit-based Incentive Payment System (MIPS) eligible clinicians who participated in the 2020 performance year of the Quality Payment Program (QPP). Data can be submitted and updated from 10:00 a.m. EST on January 4, 2021 until 8:00 p.m. EDT on March 31, 2021. How to Submit Your 2020 MIPS Data Clinicians will follow the steps outlined below to submit their data: Go to the Quality Payment Program webpage. Sign in using your QPP access credentials (see below for directions). Submit your MIPS data for the 2020 performance year or review the data reported on your behalf by a third party. How to Sign In to the Quality Payment Program Data Submission System To sign in and submit data, clinicians will need to register in the HCQIS Authorization Roles and Profile (HARP) system. For clinicians who need help enrolling with HARP, please refer to the QPP Access User Guide. Note: Clinicians who are not sure if they are eligible to participate in the Quality Payment Program can check their final eligibility status using the QPP Participation Status Tool. Clinicians and groups that are opt-in eligible will need to make an election before they can submit data. (No election is required for those who don’t want to participate in MIPS.) Small, Underserved, and Rural Practice Support Clinicians in small practices (including those in rural locations), health professional shortage areas, and medically underserved areas may request technical assistance from organizations that can provide no-cost support. To learn more about this support, or to connect with your local technical assistance organization,...
Jan 6, 2021 |
Therapy Assistants Furnishing Maintenance Therapy In the CY 2021 PFS final rule, CMS finalized the Part B policy for maintenance therapy services that was adopted on an interim basis for the PHE in the May 1, 2020 COVID-19 IFC (85 FR 27556). This finalized policy allows physical therapists (PT) and occupational therapists (OT) to delegate the furnishing of maintenance therapy services, as clinically appropriate, to a physical therapy assistant (PTA) or an occupational therapy assistant (OTA). This Part B policy allows PTs/OTs to use the same discretion to delegate maintenance therapy services to PTAs/OTAs that they utilize for rehabilitative services. Medical Record Documentation In the CY 2020 PFS final rule, CMS finalized broad modifications to the medical record documentation requirements for physicians and certain NPPs. In this CY 2021 PFS final rule, we are clarifying that physicians and NPPs, including therapists, can review and verify documentation entered into the medical record by members of the medical team for their own services that are paid under the PFS. We are also clarifying that therapy students, and students of other disciplines, working under a physician or practitioner who furnishes and bills directly for their professional services to the Medicare program, may document in the record so long as the documentation is reviewed and verified (signed and dated) by the billing physician, practitioner, or...
