As we approach the latter months of this year, this is a reminder of how the Medicare therapy cap rules apply during 2017.
Regular Medicare Therapy Cap. The annual Medicare therapy cap is $1,980 for 2017. As in past years, the cap for physical and speech […]
June 2017
CMS has very specific documentation requirements that apply to typical off-the-shelf and custom orthotics and other “DME” supplied by orthopaedic groups and hand therapy practices. DME carriers are auditing claims and specifically requesting this documentation.
Whenever a Medicare provider supplies and bills for DMEPOS […]
The following is a detailed explanation of the “in-office ancillary services” exception in the Stark Rules.
Statutory Background
Section 1877 of the Social Security Act, which is commonly referred to as the “Stark Rules,” was enacted in 1989. As originally enacted, the Stark Rules […]
DMA Clinical Coverage Policy No: 10A (amended 6/1/2017)
Medicaid patients who are over 20 have visit limits that are listed below. All visit limits refer to combined PT, OT, and ST visits from all therapy providers in any outpatient setting, including hospital outpatient […]
Should we avoid using medical terminology abbreviations?
The use of abbreviations is certainly acceptable and a practice that we use to save time because our brains work faster than our hands. A “best practice” recommendation is for each clinic to compile a list of “approved” abbreviations […]
We have been made aware that there is an issue with the NCCI edits related to the new therapy evaluation codes. If the code pairs below are billed on the same day, the code edits will generate an error indicating that these codes cannot be charged on the […]
QUESTION: What are the new physical therapy evaluation codes?
ANSWER: 97161 for a low complexity initial evaluation, 97162 for a moderate complexity initial evaluation, 97163 for a high complexity initial evaluation and 97164 for a re-evaluation.
QUESTION: What are the new […]
Dr. Tom Price, who is an orthopaedic surgeon and Republican member of the U. S. House of Representatives, has been nominated to head the Department of Health & Human Services (HHS) which includes CMS.
If confirmed, Dr. Price will be the first orthopaedic surgeon to head HHS and […]
Some payers are looking for a neuro diagnosis when 97112 is charged because it makes the connection simple. If you use 97112 for treating a […]
Evidence-Based Practice | Issue 4-2016
Article. Willy, Richard W., et al., Patellofemoral Joint and Achilles Tendon Loads during Overground and Treadmill Running, Journal of Orthopaedic & Sports Physical […]
