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Heed CMS’ ‘call to action’ for therapy providers to avoid claims disruptions

08/14/2017

Ensure you’re compliant with billing rules for dozens of therapy services and proceed with an extra dose of caution when submitting your claims, or you may be staring down the barrel of lost revenue.

Two PTs can ‘reciprocate’ summer vacation coverage – if they’re in the right areas

08/14/2017

by: Roy Edroso

Question: We have a physical therapist who wants to go on vacation and have her friend, another Medicare-enrolled physical therapist who works freelance, fill in for her. She tells us this is permissible under Medicare rules. I thought only M.D.s could do this. Who’s right? And if she’s right, how do we bill?

Whitelisting can protect your EHR — but may hobble your employees

08/14/2017

by: Roy Edroso

If you’re worried about the ransomware attacks that have been hitting medical offices lately — and who would blame you — you should consider application whitelisting as a security measure, if you can justify the potential hassle to your users.

CMS opens up hardship exception period for 2017 MIPS reporting

08/14/2017

by: Richard Scott

If you switch to a new electronic health record (EHR) in 2017 or experience another kind of technology-based disruption, you can gain a small reprieve from the reporting requirements of the merit-based incentive payment system (MIPS) — but you’re not totally excused from reporting.

Confusion over doc ‘data bank’ reigns as reports against doctors increase

08/14/2017

by: Marla Durben Hirsch

More hospitals, health plans and other entities are reporting adverse actions against doctors to the National Practitioner Data Bank (NPDB). However, there’s considerable uncertainty about reporting, which can create a mess — particularly for the doctor who is the subject of the report.

Don’t use the wrong therapy modifier — especially if you’re a therapist

08/14/2017

by: Roy Edroso

The use of therapy modifiers — GO (Services delivered under an outpatient speech language pathology plan of care); GN (Services delivered under an outpatient occupational therapy plan of care); or GP (Services delivered under an outpatient physical therapy plan of care) — changes the billing results on always- and sometimes-therapy codes, especially if you’re a therapy provider using the wrong one.

E/M codes with modifier 25 face drastic pay reduction for some practices

08/07/2017

by: Richard Scott

Watch your E/M claims appended with modifier 25 (Significant, separately identifiable E/M service) if your patients have insurance with a Medicare Advantage carrier that operates in 25 states – starting Aug. 1, payments for those E/M claims will get sliced in half.

NPPs are a proven productivity boost, but assess your practice before hiring

08/07/2017

by: Roy Edroso

A new survey supplies yet more evidence that hiring non-physician practitioners (NPPs) can increase your practice revenue – but check your practice for opportunities before making the decision.

Small practice? Medicare diabetes prevention program might not be for you

08/07/2017

by: Roy Edroso

Details on the Medicare version of the diabetes prevention program (MDPP), modified in the proposed physician fee schedule that came out last month and set to kick off in 2018, are still a little sketchy. But some observers already foresee problems for smaller suppliers — and even for physician practices that want to add it as a line of service.

CMS publishes advance copy of new interpretive guidelines to meet EM CoPs

08/07/2017

by: AJ Plunkett

No more excuses for getting ready to meet the new emergency preparedness Conditions of Participation (CoPs). CMS has published an advance copy of the interpretive guidelines for its surveyors and has provided a handy spreadsheet you can customize to show exactly what tags your organization will need to meet by Nov. 15.

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