• GPRO 2015: Is it Worth it? Image

    articleNov 19, 2014

    GPRO 2015: Is it Worth it?

    Last week, we covered the registry-and claims-based reporting methods for PQRS. In this post, I’ll discuss the complexities associated with reporting PQRS using the Group Practice Reporting Option (GPRO). In past years, GPRO seemed to be the most practical option for practices with more than two eligible professionals. This year, however, Medicare added more stipulations to the GPRO program—and in some cases, those add-ons might make the whole thing more trouble than it’s worth. The Basics of …

  • The 2015 Therapy Cap: Same Story, Different Year Image

    articleNov 18, 2014

    The 2015 Therapy Cap: Same Story, Different Year

    With all of the blog space we’ve devoted to PQRS this month, it’s easy to forget that Medicare’s final rule addresses more than just our favorite four-letter acronym. But buried deep within CMS’s annual 1, 000-plus-page behemoth of government jargon is one more major item of interest to those in the PT, OT, and SLP industries: the therapy cap. First, the good news: in accordance with the Medicare Economic Index (MEI), both cap amounts—the one for occupational …

  • PQRS 2015 Measures Image

    articleNov 17, 2014

    PQRS 2015 Measures

    While PQRS measures specifications won’t be available until December, we do know which individual measures are available for 2015. Here’s the breakdown by specialty: PT #126 Diabetes Foot/Ankle Evaluation #127 Diabetes - Footwear Evaluation #128 BMI screening #130 Current Medications #131 Pain Assessment #154 Falls Risk Assessment #155 Falls POC #182 Functional Outcome Assessment OT #128 BMI screening #130 Current Medications #131 Pain Assessment #154 Falls Risk Assessment #155 Falls POC #134 Preventative Screening Clinical Depression #173 …

  • Here's What PTs, OTs, and SLPs Need to Know About PQRS 2015 Image

    articleNov 13, 2014

    Here's What PTs, OTs, and SLPs Need to Know About PQRS 2015

    In the spirit of the season, today we give thanks for Medicare’s brand new Final Rule . Drier than overcooked turkey, we decided to carve up this bird into the most pertinent chunks of Physician Quality Reporting System (PQRS) information for you and your practice so you don’t have to. Here’s what you need to know about PQRS 2015: Measures, Measures, Measures Medicare likes measures––225 of them to be exact––and they don’t care who knows. Thankfully, all …

  • Final Rule 2015: Here’s What You Need to Know Image

    articleNov 6, 2014

    Final Rule 2015: Here’s What You Need to Know

    The summary of this year’s Final Rule is hot off the presses, which means that—among other things—we now know the details regarding PQRS 2015. For those who have been following the PQRS saga since the program first came into being in 2007, it should come as no surprise that Medicare has yet again upped the ante for compliance. Based on the fact sheet CMS provided , here’s the scoop on this year’s reporting requirements: Eligible professionals who …

  • Gifts, Donations, and Discounts: What Medicare Needs You to Know Image

    articleJul 24, 2014

    Gifts, Donations, and Discounts: What Medicare Needs You to Know

    The world of private practice physical therapy is certainly competitive, so it makes sense that owners and directors consider every angle when it comes to promoting their businesses. Unfortunately, some of those angles can get you and your practice in hot water with Medicare. Today, I’ll discuss handling gifts, donations, and discounts in a way that doesn’t rile up the big M. But before I launch into that, here’s a legal primer: Stark Law vs. Federal Anti-Kickback …

  • This Week in PT News, July 18 Image

    articleJul 18, 2014

    This Week in PT News, July 18

    CMS Releases Proposed 2015 Medicare Physician Fee Schedule Earlier this week, the Centers for Medicare & Medicaid Services (CMS) released the proposed Medicare physician fee schedule for 2015. You can read highlights of the proposed rule and access a link to view the full version here . CMS will accept public comments on the rule until September 2, 2014, and the organization is expected to release the final fee schedule on or before November 1, 2014. ACL …

  • 5 Things You Need to Know About Medicare Audits Image

    articleJul 16, 2014

    5 Things You Need to Know About Medicare Audits

    If you treat Medicare patients, then you know all-too-well that the only thing worse than having to understand—and follow—Medicare’s thick book o’ rules is having to worry about the ever-present threat of a potential audit. After all, the national media love a good fraud story , and even if you’re fairly confident that you are doing everything right, each breaking audit headline probably plants a small seed of worry somewhere deep in your subconscious. With that in …

  • Blue Cross Blue Shield and Other Payers Add FLR to Select Plans Image

    articleJul 2, 2014

    Blue Cross Blue Shield and Other Payers Add FLR to Select Plans

    As of July 1, 2013, the Centers for Medicare and Medicaid Services requires that all practice settings providing outpatient therapy services—and billing for those services under Medicare Part B—complete functional limitation reporting (FLR) on all eligible Medicare patients in order to receive reimbursement for their services. From the initial whispers of FLR, we’ve explained that private payers will most likely follow Medicare’s lead , and indeed they have. In the months since FLR became mandatory, a handful …

  • 2013 PQRS Interim Claims Feedback Data Now Available Image

    articleApr 16, 2014

    2013 PQRS Interim Claims Feedback Data Now Available

    Did you participate in claims-based PQRS reporting in 2013? If you would like to confirm that the Centers for Medicare and Medicaid Services (CMS) received your data—or if you want to review the data that you submitted—you can now do so by viewing CMS’ interim claims feedback report for 2013. According to CMS, “If you are an individual eligible professional who reported at least one PQRS quality measure in 2013 via claims-based reporting, you can now view …

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