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Medicare Benefits Policy

Medicare Documentation Requirements

September 9, 2019
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Medicare
Documentation Requirements

Initial
Evaluation and POC

The
following are Medicare’s current documentation requirements for initial
evaluation and plans of care.

I.  Initial Evaluation (from Medicare Benefits
Policy Manual Ch 15 Section 220.3(C))

A.  General
goal is […]

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Medicare Requires New CQ and CO Modifiers in 2020

August 7, 2019
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August 2019

Beginning in 2020, Medicare is requiring claims to include new modifiers showing when therapy is provided by a PTA or COTA.  The PTA modifier is CQ and the COTA modifier is CO.  (The GP, GO and KX modifiers will continue […]

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PT Management Support

KEYS TO EFFECTIVELY DOCUMENTING OUTPATIENT THERAPY (AND AVOIDING DENIALS)

July 15, 2019
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KEYS TO EFFECTIVELY DOCUMENTING OUTPATIENT THERAPY (AND AVOIDING DENIALS)

Webinar Questions and Answers

The following are questions submitted during a June 26, 2019 PT Management Support webinar on PT/OT documentation with answers.

Q: Do providers need to specify what body […]

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“DME”

DMEPOS Proof of Delivery Requirements

July 15, 2019
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DMEPOS Proof of Delivery Requirements

This is a reminder regarding Medicare’s documentation requirements for typical off-the-shelf and custom orthotics and other “DME” supplied by orthopaedic groups. DME carriers are auditing claims and specifically requesting this documentation.

Whenever your group supplies and bills for DMEPOS, your […]

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physical therapy modifiers 59

Physical Therapy Modifiers

July 2, 2019
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Medicare and UHC Ease Rules for Attaching Physical Therapy Modifiers

Medicare and UHC have announced that effective for dates of service on or after July 1, 2019, their CCI Editing policy will allow modifiers 59, XE, XP, XS and XU to be appended to either code […]

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CMS ANNOUNCES MOST COMMON PT/OT DOCUMENTATION ERRORS

June 5, 2019
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PER COMPREHENSIVE ERROR RATE TESTING PROGRAM

CMS recently published a list of the most common PT/OT documentation errors with recommendations on how to prevent these errors. CMS’s list does not contain any surprises. It includes most of the issues that PT/OT practices deal […]

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Blood Flow Restriction Training

Blood Flow Restriction Training is not PT in North Carolina May 2019

May 23, 2019
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The North Carolina Board of Physical Therapy Examiners addressed whether blood flow restriction training is within the scope of PT practice in NC at its meeting on September 14, 2017.

According to Board Rule 48C .0101 (a) Permitted Practice, “Physical therapy is presumed to include any acts, tests […]

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re-evaluate patient check list

MEDICARE WILL PAY FOR SUPERVISED EXERCISE THERAPY FOR PAD PATIENTS

February 18, 2019
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MEDICARE WILL PAY FOR SUPERVISED EXERCISE THERAPY FOR PAD PATIENTS

February 18, 2019

Medicare recently issued guidance on providing supervised exercise therapy (in the form of physical therapy) for patients with peripheral artery disease (PAD). (copy attached)

Patients will be covered for up to […]

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2019 MIPS REPORTING BY PHYSICAL AND OCCUPATIONAL THERAPISTS

December 26, 2018
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2019 MIPS REPORTING BY PHYSICAL AND OCCUPATIONAL THERAPISTS, December 12, 2018

Starting in 2019, physical and occupational therapists are included in the types of providers who participate in CMS’s Quality Payment Program (“QPP”) and start reporting Merit-Based Incentive Payment System (“MIPS”) measures.

The following […]

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Medicare’s 2019 Physician Fee Schedule

December 26, 2018
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Medicare’s 2019 physician fee schedule changes affecting PT/OT include:

KX Modifier: Although the therapy cap was repealed as of 1/1/18, the KX modifier is still required. For 2019, the KX modifier will need to be added to claims above $2 […]

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