• The Difference Between Medicare and Medicaid Billing and Reimbursement Image

    articleJul 31, 2019 | 8 min. read

    The Difference Between Medicare and Medicaid Billing and Reimbursement

    At first glance, Medicare and Medicaid might seem like twins, or a dynamic duo, or two peas in a pod—basically, inseparable. They’re both government healthcare programs; they were both created at the same time ; they’re both confusing and usually don’t boast the best reimbursement rates ; and they even sound alike (they both start with “Medi-,” right?). In reality, though, these two programs are very, very different. For starters, Medicare is a federally run program, which …

  • The Dos and Don'ts of Balance Billing Image

    articleSep 17, 2018 | 5 min. read

    The Dos and Don'ts of Balance Billing

    If you’ve been in the rehab therapy game long enough, chances are, you’ve heard a thing or two about balance billing. But, if you’re out of the loop—or if you’re wondering what balance billing is, anyway—here’s the gist, according to this article from Becker’s Hospital Review: “The practice of balance billing refers to a physician's ability to bill the patient for an outstanding balance after the insurance company submits its portion of the bill. Out-of-network physicians, not …

  • The Future of the ACA: What a Potential Repeal Means for Rehab Therapy Providers Image

    articleJan 16, 2017 | 5 min. read

    The Future of the ACA: What a Potential Repeal Means for Rehab Therapy Providers

    Policy often shifts—sometimes in large, dramatic fashion—when new leaders take office, and if Republican lawmakers stick to their word, a complete overhaul or dismantling of the Affordable Care Act (ACA) could be imminent. And that could bring about some far-reaching consequences for practitioners and patients alike—even beyond the potential for 20 million Americans to lose their insurance coverage or anyone with a preexisting condition to be stripped of important protections. It could mean higher premiums and reduced …

  • Dawn of the ICD-10: Life in the Post-Transition World Image

    articleOct 28, 2015 | 5 min. read

    Dawn of the ICD-10: Life in the Post-Transition World

    Some of you might remember all of the hype around Y2K. Rumors and speculation were abuzz, and there were people who thought all hell was going to break loose when the clock struck midnight on January 1, 2000. And then—dun, dun, dun—nothing happened. The Hyperbolic Hype The lead-up to October 1 was similar in many respects, albeit on a much smaller scale. People all over the healthcare community were freaking out about the unknown; some large practices …

  • The Ultimate ICD-10 FAQ: Part Deux Image

    articleSep 24, 2015 | 16 min. read

    The Ultimate ICD-10 FAQ: Part Deux

    Just when we thought we’d gotten every ICD-10 question under the sun, we got, well, more questions. Like, a lot more. But, we take that as a good sign, because like a scrappy reporter trying to get to the bottom of a big story, our audience of blog readers and webinar attendees aren’t afraid to ask the tough questions—which means they’re serious about preparing themselves for the changes ahead. And we’re equally serious about providing them with …

  • Pro-Bono Work: The Good, The Bad, and The Billing Image

    articleJul 20, 2015 | 7 min. read

    Pro-Bono Work: The Good, The Bad, and The Billing

    We’re all taught at a young age that it’s better to give than to receive. This saying helps children develop perspective, and even as adults, few people would argue against the moral truth of this simple axiom. In fact, I’m betting this statement really speaks to the empathetic nature of rehab therapists. Unfortunately, though, when you’re running a business (for the purposes of this blog, I’m referring to a private practice outpatient therapy clinic), you really need …

  • Why PTs Should Approach ACOs with Caution Image

    articleMay 28, 2015 | 6 min. read

    Why PTs Should Approach ACOs with Caution

    While many ACOs are enjoying success , that hasn’t been the case for everyone—especially when it comes to CMS-sponsored programs. As of September 2014, only 19 of the original 32 organizations that joined the Medicare Pioneer Accountable Care Organization program were still involved. Despite the program’s total savings of more than $384 million over two years, the economic model didn’t work for all participants. Some of the Pioneer organizations weren’t able to make large enough improvements in …

  • To ACO or Not to ACO: The Efficacy Question Image

    articleMay 20, 2015 | 4 min. read

    To ACO or Not to ACO: The Efficacy Question

    Yesterday, I told you about accountable care organizations (ACO) and how they might affect your physical therapy practice . Just one of several alternative payment models , the ACO approach seems to foster better and more expedient care, lower costs, and greater emphasis on physical therapists’ role as care coordinators. But CMS has experienced high dropout rates with its Pioneer program, and Medicare has already gone through three iterations of its ACO model, including the recent release …

  • articleSep 9, 2011 | 2 min. read

    Final Regulations for IDEA's Early Intervention Program Released

    On Tuesday, the US Department of Education released the long-awaited final regulations for the early intervention program under Part C of the Individuals with Disabilities Education Act (IDEA), a program that serves infants and toddlers through age 2 with developmental delays or conditions that have a high probability of resulting in developmental delays. These regulations will provide families, state agencies, early intervention service programs, and providers needed guidance. The department also released a notice of proposed rulemaking …

  • articleJan 31, 2011 | 3 min. read

    APTA Provides Snapshot of Regulations under Affordable Care Act

    The US Department of Health and Human Services (HHS) has released the final rule with comment period that will implement new provider screening and enforcement measures aimed at reducing fraudulent providers and suppliers from enrolling in Medicare, Medicaid, and the Children's Health Insurance Program (CHIP). The final rule also grants these federal programs authority to suspend payments when a credible allegation of fraud is being investigated. As the federal government continues the process of implementing the Patient …


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