ICD-10-CM has been the standard diagnosis coding set for a while now—since 2015, in fact—but it’s complicated enough to cause the occasional head-scratch for members of the healthcare community. But don’t worry. The ICD-10 head-scratching stops today—at least with respect to the structure of the codes
In the billing world, commercial payers have a lot of power. They set their own billing rules and guidelines; they choose how much they’ll pay providers; and they are under no obligation to unify their billing processes with other payers. When it comes to in-network billing, sometimes the game feels a little rigged. So, what happens when rehab therapists decide they don’t want to play ball? What options do they have? Well, it turns out they have a few. Enter the world of out-of-network billing.
Okay, jargon itself isn’t a bad word, but actual jargon—like the ludicrous number of initialisms that therapists have to memorize simply to navigate their profession—is pretty bad. Jargon muddies up communication, making it difficult to keep everyone on the same page and steepening the learning curve for new hires.
We have a long way to go before the world gets back to normal (or some semblance of normal), but we’ve made good progress. According to this report from the Bureau of Labor Statistics, unemployment fell to roughly 8.4% in August.
In these tumultuous times, it is of the utmost importance that we prioritize the safety of our fellow healthcare workers and patients. That is why many providers are seriously considering changing their business model and reallocating resources to telehealth—especially considering that CMS is beginning to reimburse PTs and OTs for certain telehealth services.
It all happened in an instant—or at least it felt like an instant. One day, we were living our lives as normal—going about our work days, our family and social obligations, our routines. Then came news of the outbreak, the pandemic, the national emergency—all in such rapid-fire sequence that before we even had time to process it, we were reeling from the shock of having our lives turned upside down.
Following several CMS announcements that providers were overusing modifiers 25 and 59 as a means to bypass edit pairs (without supplying proper documentation to support those bypasses), multiple commercial payers—including Anthem, Aetna, and Humana—adopted front-end claim edit policies for claims containing these modifiers.
In response to the COVID-19 pandemic, regulations are changing and loosening to help facilitate the delivery of remote rehab therapy services. That way, patients can continue to receive the care they need while simultaneously limiting the spread of the virus.
These are unprecedented times—and the rapidly changing healthcare landscape is leaving many rehab therapists feeling lost, adrift, and concerned about their future. That’s why earlier this week, our in-house experts, Dr. Heidi Jannenga, PT, DPT, ATC, WebPT Chief Clinical Officer and Co-Founder, John Wallace, PT, MS, WebPT Chief Business Development Officer of Revenue Cycle Management, and Veda Collmer, WebPT
As we reported here, as of March 17, 2020, CMS will reimburse PTs, OTs, and SLPs for certain telehealth services provided during the COVID-19 response. Specifically, these provisions apply to services that occurred on or after March 6, 2020.
If you suspect fraud, abuse, or even waste occurring in your PT, OT, or SLP practice, here are some steps for addressing it.
Over the years, we’ve written quite a few blog posts about Medicare—covering everything from Medicare and direct access to Medicare supervision requirements—and I don’t foresee that stopping any time soon. After all, there are so many intricacies and nuances to navigating Medicare that we have fodder to write until, well, either the end of time or the end of Medicare—whichever comes first.