• 4 Common Physical Therapy Billing Modifiers (and How to Use Them) Image

    articleJul 6, 2018 | 5 min. read

    4 Common Physical Therapy Billing Modifiers (and How to Use Them)

    Update: Beginning July 1, 2019, CMS will unbundle NCCI edit pairs when providers attach the appropriate modifier (59, XE, XS, XP, or XU) to either the first-column or second-column code (assuming, of course, that the situation warrants the use of one of these modifiers). Please note that while some Medicaid programs, commercial payers, and Medicare Advantage payers may follow suit, this change does not necessarily affect them, so be sure to reach out to your other payers …

  • The Cap is Gone, But KX Lives On: How to Handle Therapy Claims in 2018 Image

    articleApr 9, 2018 | 5 min. read

    The Cap is Gone, But KX Lives On: How to Handle Therapy Claims in 2018

    It happened in the middle of the night: after months of debate and hours of back and forth that went until 3 AM on February 9, 2018, the Senate voted 71-28 in favor of a stopgap budget bill—known as the Bipartisan Budget Act of 2018—that officially repealed the Medicare cap on therapy services . PTs, OTs, and SLPs around the country—especially those with Medicare claims sitting in limbo as they awaited further instruction from CMS—breathed a collective …

  • What's Going On with the 2018 Therapy Cap? Image

    articleFeb 6, 2018 | 7 min. read

    What's Going On with the 2018 Therapy Cap?

    Update: The therapy cap has been repealed as of February 9, 2018. Scroll to the last section of this post for details. Nowadays, you might be tempted to tune out, turn off, and log out at the mere mention of anything political. And considering the current climate within our legislative system, I certainly wouldn’t fault you for wanting to avoid the chaos. However, putting on the blinders could prevent you from learning crucial information. After all, the …

  • Top 10 Medicare Compliance Strategies for Outpatient Therapy Providers Image

    articleNov 15, 2017 | 16 min. read

    Top 10 Medicare Compliance Strategies for Outpatient Therapy Providers

    These days, almost everyone who works in the outpatient therapy setting has treated a patient with Medicare benefits. We have all encountered the daunting list of rules and regulations we must be follow so that: Medicare considers our documentation sufficient , and We command the highest possible level of reimbursement. From G-codes to POCs and FOMs to LTGs, it’s enough to make anyone’s head spin! With that in mind, here’s a top-10 list of helpful tips for …

  • Denial Management FAQ Image

    articleMay 26, 2017 | 22 min. read

    Denial Management FAQ

    During our denial management webinar , we discussed the difference between rejections and denials, explained how to handle both, and provided a five-step plan for stopping them in their tracks. The webinar concluded with an exhaustive Q&A, and we’ve amassed the most common questions here. Insurance Issues Claim Quandaries Compliance Qualms Documentation Dilemmas Front-Office Frustrations Insurance Issues We’ve had issues with auto insurances denying 97112 (neuromuscular re-education) for non-neuro diagnoses, even in cases when the patient’s medical …

  • Should I Stop or Should I Go? What to Do When a Patient Hits the Therapy Cap Image

    articleNov 7, 2016 | 4 min. read

    Should I Stop or Should I Go? What to Do When a Patient Hits the Therapy Cap

    Halloween and the whole pretend thing may be over, but follow me for a second: when a Medicare patient comes to you for treatment, it’s critical that you also play the roles of investigator and lawyer (though costumes are optional). Clearly documenting the therapy services you are providing during the current benefit period —without skimping on the details—can potentially save you from an audit. In fact, your documentation is like evidence in a court case . So, …

  • MAC Madness: When and How to Contact Your Medicare Contractor Image

    articleNov 4, 2016 | 4 min. read

    MAC Madness: When and How to Contact Your Medicare Contractor

    Medicare providers have a lot of challenges to contend with—and meeting those challenges can be tough. But, you don’t always have to go it alone, because while you can’t always count on CMS to provide clear guidance on how to comply with all the regulations that apply to you, you do have other resources at your disposal when you need answers—quick. Let’s talk about one such resource: your Medicare Administrative Contractor (MAC). Your Medicare Go-To Even if …

  • The Definitive Medicare Part B FAQ for Outpatient PT, OT, and SLP Image

    articleOct 27, 2016 | 33 min. read

    The Definitive Medicare Part B FAQ for Outpatient PT, OT, and SLP

    In October, we hosted a webinar dedicated to the most common Medicare misconceptions . We received a lot of questions from the audience—so many, in fact, that we’ve organized them all into one huge FAQ. Scroll through and check them out, or use the link bank below to skip to a particular section. The Therapy Cap ABNs Modifiers Supervision Prescriptions and Certifications Cash-Pay Rules and Regulations Re-Evaluations Everything Else   The Therapy Cap If a patient reaches …

  • Medicare Part A vs. Part B: What PTs, OTs, and SLPs Need to Know Image

    articleOct 7, 2016 | 8 min. read

    Medicare Part A vs. Part B: What PTs, OTs, and SLPs Need to Know

    Whether you’re just starting out as a Medicare provider—or you’re making the switch from inpatient to outpatient—there’s a lot to keep straight when it comes to the complicated rules, regulations, and policies that govern Original Medicare (which consists of both Part A and Part B). But if you want to receive reimbursement for your services, you’ve got to know how to navigate the murky Medicare waters. So, what does Medicare Part A cover—and what do you need …

  • 9 Most Common Medicare Misconceptions for PTs, OTs, and SLPs Image

    webinarSep 8, 2016

    9 Most Common Medicare Misconceptions for PTs, OTs, and SLPs

    To say that Medicare regulations are confusing is an understatement. But, it’s not just the barely-readable government gobbledygook that throws providers for a loop; it’s also the fact that the rules are always changing. If you treat Medicare patients, we’re willing to bet you’ve been tripped up by at least one of these common misconceptions—maybe without even knowing it. And that could leave a nasty bruise on your practice’s bottom line—especially if you ever find yourself at …

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