The IRG Report


24

Aug 2015

Don't Get Tripped Up by Therapy Plan of Care and Certification Requirements

One of the most common errors I see when reviewing therapists’ documentation is also one of the most easily rectified.  Too often, therapists either neglect to update their plans of care for Medicare beneficiaries on a timely basis or fail to have those plans of care certified by a physician.  Failure to do either of these can result in a...

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27

Jul 2015

Proposed 2016 Medicare Physician Fee Schedule and Potential Implications for Therapy

The first proposed Medicare physician fee schedule rule since the enactment of the Medicare Access and Reauthorization Act of 2015 (MACRA) was released by CMS earlier this month.  CMS will review public comments submitted by September 8th and will then publish the final rule by November 1st.  Some highlights of the proposed fee schedule which will have an impact on...

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16

Jul 2015

Palmetto Recognizes Incorrect Denials of 97140

Palmetto GBA has posted a notice on its Claims Processing Issues Log regarding recent denials of the 97140 CPT code.  This code is commonly used by physical and occupational therapists to bill manual therapy procedures.  Palmetto has determined that Part B claims for 97140 codes may have been denied in error based on an edit applied on June 18, 2015...

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13

May 2015

CMS to Revise Manual Medical Review Process for Therapy Services

The “Medicare Access and CHIP Reauthorization Act” enacted last month included several provisions that will have a direct impact on outpatient therapy services over the next couple of years.  In addition to the extension of the therapy cap exceptions process reviewed in the previous blog post, the bill also calls for the Secretary of Health and Human Services to implement...

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16

Apr 2015

Therapy Cap Exceptions Process Extended; Full Repeal of Caps Narrowly Misses

On April 14th, 2015, the Senate passed legislation that repeals and replaces the sustainable growth rate (SGR) formula used to determine payments to providers for outpatient services, including outpatient therapy.  The reform package will provide for a 0.5% increase in reimbursement for services under the Medicare Physician Fee Schedule and avoids a 21.2% reduction that was scheduled to go into...

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01

Apr 2015

Here We Go Again

In a scenario that is all too familiar to many therapy providers, the clock has run out on the therapy cap exceptions process and the manual medical review process, which are both set to expire at midnight tonight (3/31/15). We were encouraged on Thursday after the House passed legislation which would have avoided the 21% cut in Medicare payments and...

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10

Mar 2015

Update on the 2015 Therapy Cap and Exceptions Process

As we move further into March, clinicians (and even patients) have been asking what to expect at the end of this month as the current therapy cap exceptions process expires.  As you may recall, the Protecting Access to Medicare Act of 2014, enacted on 4/1/14 and best known for delaying the implementation of ICD-10, also extended the therapy cap exceptions process through...

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30

Dec 2014

Are Your Therapists Ready for the 2015 PQRS Changes?

As mentioned last month, significant changes are on the horizon for therapists who have been participating in the PQRS program. (See “Final 2015 Physician Fee Schedule Rule Includes Changes for Therapy Providers”; 11/7/14.)  It’s not all bad news, but therapists will definitely see an increase in the amount of reporting and documentation required if they want to avoid negative payment adjustments...

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12

Dec 2014

CMS to Hold on Implementing -59 Modifier Subset for Therapy Providers

Earlier this year, CMS announced that it had established four new modifiers to define subsets of the -59 modifier.  According to CMS, because of its broad application, the -59 modifier is the most widely used modifier and has become associated with abuse and high levels of manual audit activity.  As a result, CMS defined four new HCPCS modifiers which will...

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Best in the Shoals

04

Dec 2014

Best in the Shoals

Congratulations to North Alabama Bone and Joint Rehab for being named winner of “for Personal Service – Physical Therapy” in the Times Daily Readers’ Choice 2014 Awards!  Pictured L-R are IRG team members Kristy Whitaker, LPTA; Gail Haddock, CSS; Mareth Poag, LPTA; Joann Campbell, CSS; Bradley Noland, aide; Amy Downey, PT; James Branham, OT, CHT  



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