• The Pros and Cons of Opting into MIPS Image

    articleFeb 18, 2019 | 8 min. read

    The Pros and Cons of Opting into MIPS

    I’ve spent an enormous amount of time researching MIPS —from digging through the 2,000-odd pages of the final rule and decoding line upon line of legalese, to participating in hour-long discussions (and dozens of email chains) with WebPT’s compliance experts. After all that researching, I feel pretty comfortable with the ins and outs of the program—as well as its benefits and drawbacks. So, let’s talk shop. Here are the pros and cons of MIPS participation : Pros …

  • The Secret to Documenting for Medical Necessity Image

    articleDec 27, 2018 | 8 min. read

    The Secret to Documenting for Medical Necessity

    Around the holidays, everyone seems to get excited about closing out the year with a bang— literally, in some cases . But there’s nothing wrong with closing out the year on a calm, gentle note—one without denials, for example. One of the best ways to avoid claim denials is to document defensibly, and to prove that your treatment was undeniably (haha—get it?) a medical necessity . So, what exactly is medical necessity? Don’t worry—that’s one term we’re …

  • 8 Simple Rules for Creating a Medicare POC Image

    articleDec 3, 2018 | 5 min. read

    8 Simple Rules for Creating a Medicare POC

    “Simple” and “Medicare” are rarely used in the same sentence, but that doesn’t have to be the case—especially when it comes to developing physical therapy, occupational therapy, and speech-language pathology plans of care (POCs) and adhering to certification requirements. While these treatment outlines might seem daunting at first, there are totally easy-to-follow guidelines to ensure yours are always comprehensive and compliant. To that end, here are eight simple rules for creating a Medicare POC—so you can provide …

  • Should My PT Practice Participate in MIPS? [Quiz] Image

    articleNov 29, 2018 | 1 min. read

    Should My PT Practice Participate in MIPS? [Quiz]

    In 2019, some physical, occupational, and speech therapists will be required to participate in Medicare's Merit-Based Incentive Payment System (MIPS) —a mash-up of the Physician Quality Reporting System (PQRS), Meaningful Use (MU), and Value-based Modifier (VM) programs. Others will be able to opt-in, and still others will be excluded from participating at all (except in a voluntary manner that leaves them ineligible to receive the payment incentive or adjustment). Not sure where your practice stands? Take this …

  • Everything You Need to Know About POPTS Image

    articleNov 26, 2018 | 6 min. read

    Everything You Need to Know About POPTS

    From day one of physical therapy school, we were taught to not even entertain the idea of working for a POPTS practice. I remember hearing the words, “Your license is on the line,” and feeling vaguely scared of the potential fallout from joining one of these heinous practices. But, I was so overwhelmed by the immediacy of school concerns that I didn’t take the time to consider why. I never did work for a POPTS clinic, but …

  • 5 Medicare Compliance Issues for Cash-Based PTs Image

    articleNov 20, 2018 | 6 min. read

    5 Medicare Compliance Issues for Cash-Based PTs

    Cash-based physical therapy practices are all the rage these days, and with good reason. They give PTs the opportunity to focus on providing quality care—without the pressure of altering treatments or billing practices to keep insurance payers happy. At the same time, PTs can get into hot water if they blindly accept cash from anyone willing to pay. And things get especially hairy when it comes to Medicare patients. So, can a Medicare patient pay out of …

  • Double Duty: How to Bill for PT and OT on the Same Day Image

    articleNov 12, 2018 | 6 min. read

    Double Duty: How to Bill for PT and OT on the Same Day

    In many cases, physical therapy and occupational therapy go together like peanut butter and jelly. PTs and OTs often share similar goals and interventions, treat the same types of patients in the same settings, and get confused by the billing rules that apply to our respective specialties. This confusion leads to quite a few questions, including this head-scratcher: how does one bill for OT and PT provided to a single patient on the same day? While the …

  • Spot the Difference: Rules for Medicare vs. Medicare Advantage Image

    articleNov 9, 2018 | 5 min. read

    Spot the Difference: Rules for Medicare vs. Medicare Advantage

    Medicare and Medicare Advantage (MA) plans have similar structures, because MA plans are required to (at minimum): offer the same benefits that traditional Medicare provides to its beneficiaries, and adhere to all CMS National and Local Coverage Determinations. However, there are some significant differences between the two . And that makes sense given that traditional Medicare is government-operated, while Medicare Advantage plans are operated by Medicare-approved private companies. Thus, many of the core Medicare requirements don't automatically …

  • Founder Letter: What to Do About MIPS in 2019 Image

    articleNov 6, 2018 | 9 min. read

    Founder Letter: What to Do About MIPS in 2019

    As 2019 looms, we've been getting a lot of questions about Medicare's Merit-Based Incentive Payment System (MIPS) —specifically, whether or not all physical, occupational, and speech therapists need to report and, if there is a penalty, how to avoid it. These are both great questions—and luckily, fairly easy ones to answer. But one of the reasons why there is so much confusion swirling about Medicare's latest reporting program is that there's a lot of misleading information—and even …

  • CMS’s Final Bow: The 2019 Final Rule Image

    articleNov 5, 2018 | 8 min. read

    CMS’s Final Bow: The 2019 Final Rule

    Last week, the Centers for Medicare and Medicaid Services (CMS) published its 2019 final rule . Clocking in at just over 2,300 pages, the final rule isn't exactly a light read—especially because the legal lingo can be harder to interpret than Shakespearean verse. Luckily, we have the script—with all its twists and turns—decoded and ready for you to review. Here's the synopsis of all the physical therapy, occupational therapy, and speech-language pathology Medicare changes for 2019: Out, …

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