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The New MPPR for Therapy Providers Explained

Have you noticed additional adjustments on your Medicare remittance advice this year?  I have received many questions from therapy providers this year regarding the new MPPR  (Multiple Procedure Payment Reduction) and what it means for their clinics.   In a nutshell, Medicare is applying a reduction to the practice expense portion of the payment for a […]

Alert: Big Changes Coming for Medicare Therapy/Rehab Providers

Changes Ahead for Therapy Providers The 2011 Medicare Physician Fee Schedule Final Rule has been released—all 2023 pages of it.  How does the final rule affect physical therapy and rehab providers?  Here is the breakdown: Therapy caps: 2011 outpatient therapy cap will be $1870 (page 382) The exceptions process to the therapy caps will expire on December […]

Would Your Documentation Stand Up to a Medicare Audit?

Documentation under the Magnifying Glass Facts & findings from recent Medicare audits reveal 3 main areas where payment errors were identified.  The  results?  Charges denied as “Insufficient Documentation” ….leading to recoupment. The 3 most common deficiencies were: Illegible or missing signatures on documentation or orders Signature requirements are nothing new–but CMS and its audit contractors […]

New Timely Filing Limits for Medicare–Be Prepared!

Medicare has had a history of  very generous timely filing limitations over the years.  However, as the old song lyrics go, “Times, they are a’changing”.   While in years past, some claims could be submitted as much as 2 years from the date of service,  new legislation changed the timely filing limts to one calendar year from the […]

PECOS: Are You Enrolled? Are Your Referring Dr’s?

Are your providers currently enrolled in the Medicare PECOS system?  Are the providers who regularly refer patients to your clinic enrolled? PECOS:  Provider Enrollment, Chain and Ownership System Many providers are still unaware of the PECOS system, the need for enrollment, and the negative impact that failure to enroll could have on their practice. Although […]

Chiropractors Under the Magnifying Glass of Medicare

Is your practice prepared? Multiple audits performed by TrailBlazer, the Office of the Inspector General and most recently the Comprehensive Error Rate Testing (CERT) contractor have revealed unacceptably high numbers of inappropriately paid claims for chiropractic manipulation. Findings echoed previous results of government auditors. As a result, Chiropractors can continue to expect their claims to […]

Patient Action Alert: Stop the Therapy Cap!

The exceptions process for patients needing physical, occupational, and speech therapy beyond the capped amount ended December 31, 2009. Currently there are two therapy caps, one for physical therapy and speech therapy combined and one for occupational therapy. The 2010 therapy caps are set at $1860 per beneficiary per year. The therapy cap applies to […]

New Place of Service (POS) Code: Walk-in Retail Health Clinic

Mark your calendars!  A new place of service code goes into effect May 1, 2010. Billers and managers for these types of clinics should check with their practice management software companies and clearinghouses to be certain that the new code will be added before the effective date.  They will also want to notify their billing […]

Today’s Tip: Submitting Paper Secondary Claims

A good number of provider offices are still submitting secondary claims on paper rather than electronically for a variety of reasons.  Today’s tip was written with the goal of reducing the number of denied secondary paper claims by making just a  few simple changes. Basic information New billing staff should understand that the secondary insurance […]

Falls Prevention Awareness Day and Physical Therapy Assessments

As the nation observes Falls Prevention Awareness Day on September 22, the American Physical Therapy Association (APTA) is urging older adults to schedule a balance and falls assessment with a physical therapist to reduce risk of falls and related injuries. Does your practice offer falls risk assessments? Are your referring Dr’s aware that you offer […]

Medicare Feedback—Chiropractic Documentation Errors

I often receive calls and emails pertaining to chiropractic services and mysterious Medicare denials and requests for documentation.  There can be a number of reasons for both.  I will be releasing more articles on specific billing issues that are common to chiropractic services, but today we will focus on documentation errors due to the timeliness […]

Avoid Unnecessary Denials! Use your Medicare Local Coverage Determinations!

What is a “Local Coverage Determination” (LCD)?                                                                                          Medicare contracts with private companies like Palmetto, Noridian, Novitas, etc. to administrate—process and pay claims in a specific region. Medicare Carriers and Fiscal Intermediaries (FIs) are private companies that Medicare contracts with to pay bills. More recently some FI’s have been replaced with the MAC […]

Today’s Tips

As you may have figured out by now, complete and accurate VOBs are one of my pet peeves!  We at CRT regularly update our forms to stay on top of the latest developments and the changing needs of our clients. DO review and evaluate your VOB form often and make note of any changes that […]

Today's Tips

As you may have figured out by now, complete and accurate VOBs are one of my pet peeves!  We at CRT regularly update our forms to stay on top of the latest developments and the changing needs of our clients. DO review and evaluate your VOB form often and make note of any changes that […]

V.O.B. Tip of the Day—Medicare Secondary Plans

As mentioned yesterday, verification of benefits (V.O.B) is the 1st step in the billing process and it will affect your bottom line. Today’s tip/trend is related to Medicare beneficiaries and their secondary coverage.  Many practices incorrectly assume that if a patient has a secondary plan to Medicare, that the Medicare deductibles and coinsurance portions will […]