February 17, 2012

Congress Passes Legislation to Prevent Payment Cuts

News

Congress passed legislation to prevent the Medicare payment cuts. The next step will be for the bill to go to the President for signature. This, I’m sure he will do with pleasure as it is attached to the bill renewing the payroll tax cuts and the jobless benefits. The whole bill is expected to cost $143 billion. See our previous post for more details of the Medicare changes.

Congress Making Deal to Forestall Medicare Cuts

News

Late yesterday the Congressional Conference Committee released the details of a deal that would prevent the 27.4% payment cut to Medicare providers scheduled to take place on March 1. The Geographic Practice Cost Index (GPCI) will be maintained at the current level along with an extension of the therapy cap exceptions process till the end of the year. However there are a few provisions included with this extension. a) Continues consistent use of the KX modifier when the cap ($1880 for 2012) is met provided the patient continues to meet …
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February 16, 2012

HHS to Delay Implimentation of ICD-10

News

HHS has now indicated that it is ready to look at postponing the implimentation od the ICD-10 system in October next year. To learn more visit the ICD Monitor through this link

February 15, 2012

CMS Issues Proposed Rule for Reporting and Returning of Overpayments

News

On Tue Feb 14, CMS proposed that providers and suppliers must “report and return self-identified overpayments either within 60 days of the incorrect payment being identified or on the date when a corresponding cost report is due, whichever is later.” The new announcement is one in a series of steps Medicare is taking to protect taxpayer dollars, including efforts to prevent overpayments from occurring. These efforts include letting private auditors working on behalf of Medicare catch wasteful spending before it happens,by expanding the use of Recovery Audit Contractors; testing changes …
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January 20, 2012

Our Seminars For 2012

News

We have changed how we will be presenting our live seminars for 2012 by scheduling both our SNF and Outpatient Part B seminars over the same weekend. This will help in keeping our registration price down for these presentations. We will be presenting Mastering Medicare: A Practical Guide To Succeeding Under RUG IV on a Friday; the Anatomy of Documentation, which was the second day of last year’s Mastering Medicare, will be scheduled on the Saturday with Tests, Measures & Questionnaires following on Sunday. This change in format will allow …
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January 6, 2012

Legislation Passed to Prevent Caps and Cuts Until February 29, 2012

News

It was the night before Christmas and all through the House (and Senate) members of Congress wanted to get home and so they did what Congress has been doing for the last 5 years (other than in 2010) and passed a stop-gap measure to prevent the reduction in the PFS of almost 28% and to extend the exception process until February 20th 2012. (Actually, it was not really the night before Christmas but almost.) Talk about déjà vue all over again. Both houses had already passed legislation to address the …
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July 4, 2011

CMS Publishes The Proposed Rule For Part B Services 2012

What's New Part B

CMS published the Interim Final Rule for Part B services for fiscal year 2012 on July 1st and guess what, we’re back to the same old story as in previous years, except it just keeps getting worse each year. The flawed sustainable growth rate (SGR) which has been a problem for many years, which is acknowledges as flawed and which has had no action to correct, is still in place. For those of you who are not aware , the SGR has been on a negative index for several years. This …
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February 21, 2011

HEAT Task Force Strikes Back

What's New Part B

The Department of HHS announced that a combined action by the HEAT task forces had made arrests in several areas including Brooklyn, Los Angeles, Detroit and Miami. The round up follows investigation of fraud in billing Medicare services and identified over $240 million in fraudulent claims. Unfortunately Physical Therapy was one of the Medicare benefits that was under scrutiny with at least three different schemes. A Physical Therapist in New York was accused of fraudulently bill over $11.9 million in claims between January 2005 and June 2010. These claims were …
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February 5, 2011

New Private Practice PT Providers Under More Scrutiny

What's New Part B

The government’s fight against the increasing prevalence in Medicare and Medicaid fraud has taken a new turn which puts a spotlight on PTs in private practice above other therapy providers! Starting March 25th 2011, additional provisions are being put in place to screen new providers and suppliers of Medicare services, along with existing providers and suppliers who are revalidating their Medicare participation. The new regulations outlined in the Final Rule published February 2nd, authorizes 3 levels of additional screening based on assessed risk. Under the new rule CMS will require …
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January 10, 2011

OIG Releases Reports on Questionable Billing Practices

What's New Part B

Late last month, the OIG released two reports on “Questionable Billing Practices”, one for Medicare Outpatient Therapy Service and the other for SNF Part A Services. The findings in both of these reports was of high overutilization of services with both abuse and fraud occurring. The recommendations for both of these reports were to increase scrutiny of claims submitted and institute changes to the ways that payment for these services are created. What they found: For outpatient therapy services, 20 counties were identified that, in 2009, had provided 1) the …
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