Tag: Medicare Part B

Frequently asked questions about Medicare Part B

Source: The Bottom Line Q: How should multiple units of the same HCPCS code given on the same day be listed on the UB-04 (e.g., four units of 97530 in occupational therapy)? A: Units of the same HCPCS code provided by the same discipline on the same day should be listed on the same line […]

Scrutinizing Medicare coverage for physical, occupational and speech therapy

This article has been republished with permission from the author, Judith Graham, Kaiser Health News. For years, confusion has surrounded the conditions under which older adults can receive physical, occupational and speech therapy covered by Medicare. Services have been terminated for some seniors, such as those with severe cases of multiple sclerosis or Parkinson’s disease, […]

Ethical principles for long-term care billers

The following post is an excerpt from Medicare Guide for SNF Billing and Reimbursement by Janet Potter, CPA, MAS, and Frosini Rubertino, RN-CNE, CDONA/LTC, CPRA. The following ethical principles are based on the core values of The Billers’ Association for Long-Term Care. They apply to all members. Long-term care billing professionals shall do the following: […]

Two-year budget deal repeals therapy caps, cuts skilled nursing spending by $1.96 billion

Last week, President Donald Trump signed a two-year federal budget deal that left long-term care providers sighing with relief at the repeal of therapy caps for Medicare Part B beneficiaries retroactive to January 1, followed by a sigh of disappointment with a $1.96 billion cut to skilled nursing facility (SNF) spending. The cuts include a payment […]

CMS recommends billing staff become aware of updates to “Always Therapy” code edits

The Centers for Medicare & Medicaid Services (CMS) recently published an update that deleted the procedure code 97532 from the list of “Always Therapy” codes used to track the Medicare Part B therapy caps. The coding requirement change is effective for services furnished on or after January 1, 2018. CMS notes that this update contains […]

CMS offers new settlement option for appeals pending at OMHA and DAB

On November 3, 2017, CMS announced that they will offer an additional settlement option for providers and suppliers (appellants) with appeals pending at the Office of Medicare Hearings and Appeals (OMHA) and the Medicare Appeals Council (the Council) at the Departmental Appeals Board. The low volume appeals settlement option (LVA) will be limited to appellants […]

20% of Medicare ambulance claims have inappropriate billing for transport

CMS reports that in a September 2015 report, the Office of the Inspector General (OIG) released results of a study of Medicare Part B ambulance claims. According to the report, almost 20 percent of ambulance suppliers had inappropriate and questionable billing for ambulance transport, creating vulnerabilities to Medicare program integrity. The OIG identified a number […]

CMS scrutiny of updates to Part B therapy coding to begin January 2018

In a recent MLN Matters article, the Centers for Medicare & Medicaid Services (CMS) published revisions to editing of Part B “Always Therapy” services, identifying outpatient therapy (OPT) services that must always be accompanied by a discipline-specific therapy modifier. CMS states that Change Request (CR) 10176, intended for therapists, physicians, and certain other practitioners billing […]

MedPAC’s June report is in: Summary here

The Medicare Payment Advisory Commission (MedPAC) published their June Report to the Congress: Medicare and the Health Care Delivery System, in which they evaluate several Medicare payment issues in order to make recommendations to Congress. Issues addressed include: Implementation of a unified payment system for post-acute care. Given the overlap among PAC settings (skilled nursing […]

Change to Advanced Beneficiary Notice of Noncoverage

Providers should be using the updated Advance Beneficiary Notice of Noncoverage (ABN), Form CMS-R-131, beginning June 21, 2017 (but may begin using the new forms prior to this date). There are no changes to the form itself, however, providers should take note of the new expiration date of March 2020. The ABN is issued by […]