• 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 …

  • Should PTs, OTs, and SLPs use the New X Modifiers? Image

    articleNov 7, 2018 | 4 min. read

    Should PTs, OTs, and SLPs use the New X Modifiers?

    When it comes to Medicare, a lot can change in four years—whether it be the rise and fall of functional limitation reporting or answers to questions like, “Do outpatient rehab therapists have to report MIPS?” (You can get that answer here , by the way.) So, when CMS introduced the X modifiers back in 2015 and told PTs, OTs, and SLPs they wouldn't have to use them, anyone familiar with Medicare rules knew that advice was subject …

  • 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, …

  • Plandemonium: Everything PTs Need to Know About Medicare Original, Advantage, and Supplement Plans Image

    articleOct 30, 2018 | 6 min. read

    Plandemonium: Everything PTs Need to Know About Medicare Original, Advantage, and Supplement Plans

    Generally speaking, Medicare is a federally funded health insurance program  that provides benefits for people who are 65 or older; people with disabilities; and people with end-stage renal disease. Each part of Medicare—A, B, C, and D—covers a distinct set of services and benefits. Then, there are Supplement Plans that fill in some of the gaps. Not sure how Part C differs from Part A—or what gaps a Supplement Plan could possibly fill? How about Original Medicare …

  • Common Questions from Our Medicare Open Forum Webinar Image

    articleOct 25, 2018 | 43 min. read

    Common Questions from Our Medicare Open Forum Webinar

    Earlier this week, WebPT President Dr. Heidi Jannenga, PT, DPT, ATC, teamed up with Rick Gawenda, PT—President and CEO of Gawenda Seminars & Consulting—to host a Medicare Open Forum . As expected, we received more questions than our Medicare experts could answer during the live session, so we've provided the answers to the most frequently asked ones below. Don't see the answer you're looking for? Post your question in the comment section at the end of this …

  • Denied but Not Dead: How to Submit a Medicare Appeal Image

    articleOct 15, 2018 | 9 min. read

    Denied but Not Dead: How to Submit a Medicare Appeal

    You know the drill: you provided Medicare-covered, medically necessary services to a patient who has active Medicare coverage. And yet, for some reason, CMS denied your claim. While you could chalk it up to a complicated government payer system and write off the costs of those services, that may not be the best solution—especially if you have the documentation to support the validity of your claim. In that case, you may very well want to appeal Medicare’s …

  • 7 Things to Do When Medicare Requests Your Patient Records Image

    articleOct 10, 2018 | 5 min. read

    7 Things to Do When Medicare Requests Your Patient Records

    October is finally upon us, which means it’s time for spooky memes , pictures of Corgis in costumes , trick-or-treating, and a scary story or two. If you’re a physical therapist, occupational therapist, or speech-language pathologist, though, there are few tricks more bone-chilling than the prospect of a Medicare audit . But, here’s a treat: being audited by Medicare doesn’t have to be a fright fest. Just make sure you follow these tips: 1. Have a procedure …

  • When to Use the KX Modifier Image

    articleOct 8, 2018 | 3 min. read

    When to Use the KX Modifier

    In the months since the elimination of the hard cap on therapy services , it seems like rehab therapists are more confused than ever about when they should affix the KX modifier versus issue an Advance Beneficiary Notice of Noncoverage (ABN) . The truth of the matter is that not much has changed operationally since the Medicare therapy cap repeal—aside from the name of the cap (i.e., what was once the “hard cap” is now called the …

  • Top Takeaways From #AscendEvent 2018 Image

    articleOct 2, 2018 | 9 min. read

    Top Takeaways From #AscendEvent 2018

    This was my first year attending WebPT’s Ascend conference , and I wasn’t sure what to expect. A business conference? For PTs? It was exciting and intriguing. I also received carte blanche to write an entire blog post around my own experiences at the conference, which is an absolute dream come true! And, as a non-traditional, non-practicing physical therapist, I knew my experience would be very different from others’. So, I packed my bags and braced myself …

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