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Eli's Rehab Report

Outpatient Outlook:
Know the Physician Fee Schedule Changes That Affect You
CMS’ ‘misvalued codes’ list hits rehab hard this time around. The Me... Read more
Practice Pointers:
Increase Patient Compliance with a Solid No-Show Policy
How patients value your services is key to their attendance. No-shows and cancellation... Read more
Claims Audit:
Is Your Plan of Care An Audit Hotspot? Take Action Before the OIG Does
Reminder: Your payments hinge on a Medicare-compliant plan of care. Therapists must pa... Read more
Skilled Nursing Facilities:
Your Changes in Therapy Billing Gets Increased Scrutiny
OIG discovered that SNFs increased their billing for the Ultra High RUG category since 2... Read more
Therapy Caps:
Heed 4 Quick Expert Tips For Billing Therapy Over The Cap
Don’t wait until the second progress report to reevaluate medical necessity. The... Read more
Final 2016 Per-Visit Amounts for LUPAs and Outliers
Rates are 2 percent lower for agencies that do not submit quality data. Source: CMS... Read more
Industry Notes
Doctor in Hot Water for Billing Massage Therapist's Services as PT Some people mig... Read more
Payment Reform:
Put It on Your Radar: New Joint Replacement Payment Demonstration for Hospitals
Post-acute care providers could use this to their advantage. Starting in January, more... Read more
Review Where You Stand with ICD-10 Implementation
Note elimination of therapy V codes. Understanding how to report the famous “se... Read more
Claims Reviews:
How The New Guidance Is Especially Positive For Therapy Appeals
Understand how review limitation will affect your over-cap therapy claims. If you&rsqu... Read more
Case Study:
Check Out This Agency's Stabilization Scenario
“Isn’t part of the mission of home care to assist clients to remain in the h... Read more
Industry Notes
Claims System Fix For LUPA Glitch Leads To Errors A new home health claims system edit... Read more
Outpatient Outlook:
PT Self-Referral in the Hot Seat Once Again
New study exposes unsettling trends in outcomes and expenditures. If you’ve been... Read more
Coding Corner:
ICD-10: Try Your Hand at a Foot Fracture Case
Key: Choose carefully between 7th characters ‘A’ and ‘D.’ A pa... Read more
Cover These Errors And Avoid Denials
Do you remember to tie goals to functional improvement? Home Health & Hospice Medi... Read more
Protect Your Therapy Dollars This Way
Tip: Ensure goals are realistic. If you have been wondering whether capturing deserved... Read more
Medical Review:
Your Reimbursement Could Hinge On Capturing These 11 Therapy Elements Consistently
Ensure patient’s records support services furnished. Build a template ensuring t... Read more
ICD-10 Transition:
Get Your ICD-10 Coding Right The First Time
MAC puts providers on notice. If you thought you might get a little leeway as ICD-10 t... Read more
Prepare for Dual Coding on Workers' Comp Claims
Not all states are switching to ICD-10. Effective Oct. 1, you might need to use both I... Read more
Industry Notes:
Watch Out For That PQRS Letter
If you have not received that all important letter from the Centers for Medicare & M... Read more
Worker's Comp:
Extended Cases? Know When to Hold 'Em and When to Fold 'Em
Learn how to avoid sending red flags to your worker’s comp payers. Do you have ... Read more
Therapy Claims:
Tighten Up Your Claims With These 10 Tips
Hint: Medicare may not reimburse all therapy modalities on same day service. Do you ke... Read more
ICD-10 Transition:
Prevent SNF Billing Snafus After ICD-10 Implementation
Plus: Arm yourself with a wealth of information from these new resources from CMS. If ... Read more
Industry Notes
Is ICD-10 Delayed for A Year? When the Centers for Medicare & Medicaid Services (C... Read more
Reader Questions:
Is A Hospice Patient Qualified for Therapy?
Question: A resident was admitted to our skilled nursing facility for a respite sta... Read more
Reader Questions:
Check Out This Help From Medicare's Billing Manual
Question: Can I count therapy minutes on a “skip day” (when the residen... Read more
Reader Questions:
Grasp the Group Therapy Billing Nitty-Gritty
Question: What code(s) should be used to bill for a Medicare patient’s partic... Read more
What Does 2016 Have In Store For You?
CMS proposes revisions to payment policies. Therapists can heave a sigh of relief as t... Read more
Practice Pointers:
Take Your Documentation to the Next Level, Part 2: Follow-Up Visits
If you’re not meeting these key standards, your reimbursement could be on the chop... Read more
Learn The Difference Between NCDs and LCDs Before You Face Claims Denials
If you’ve ignored the alphabet soup of LCDs versus NCDs thus far, it’s time ... Read more
ICD-10 Coding:
Eliminate Confusion On Coding Guidelines Under ICD-10
Tip: Don’t throw away your current coding rule book after Oct. 1. You might need... Read more
Therapy Claims:
Review Your PT Claims' Records To Eliminate These Deficiencies
Only 38 percent of claims were billed properly by this practice. If you think clear, d... Read more
Industry Notes:
SGDs Removed From Capped Rental
Medicare beneficiaries who need speech-generating devices (SGDs) have cause to celebrate... Read more
Practice Pointers:
Take Your Documentation to the Next Level, Part 1: The Initial Evaluation
If you’re not meeting these key standards, your reimbursement could be on the chop... Read more
Meet Documentation Requirements To Safeguard Your Reimbursement
Tune in to the OIG Work Plan mid-year update. On May 28, 2015, the Office of the Inspe... Read more
ICD 10 Update:
Safe Harbor Proposed For ICD-10 Transition
New legislation to protect providers’ reimbursement. There’s good news for... Read more
Why Is Appropriate Documentation Crucial For Therapists?
Get help from APTA. If you have been wondering why there is a spotlight on documentati... Read more
ICD-10 Coding:
Gain More Choices And Specificity With CVA Sequelae Codes
Make the most of multiple code choices. It’s time to get up to speed on ICD-10 c... Read more
Industry Notes:
Reduce Denials Due To Insufficient Documentation
There’s help from Medicare forthcoming on documentation tips. 8 MACs, including Ca... Read more
Industry Notes:
HHS Turning Up The HEAT
In the largest ever raid effected by the Medicare Fraud Strike Force, 243 individuals we... Read more
Industry Notes:
Latest ICD-10 Testing Results Show Positive Progress
If you had any doubt that the Centers for Medicare & Medicaid Services (CMS) is seri... Read more
Reader Questions:
Should You Reply In The Same Way When Contacted Via Social Media?
Question: What if someone contacts our practice through social media and asks quest... Read more
Reader Questions:
Heed the POS for Rehab Inpatients
Question: One of our physicians was called and asked to do a consult on an inpatien... Read more
Outpatient Outlook:
Catch the Finer Details of MACRA Legislation Before They Catch You
…and refresh your therapy cap knowledge, while you’re at it. A big victor... Read more
Watch for Consolidation of Quality Programs
Not surprisingly, the MACRA legislation adds fuel to quality-based reimbursement fire, a... Read more
Therapy Caps:
Yes, You Still Have The Therapy Cap Exceptions Process
Industry stakeholders won’t give up the fight to eliminate cap. Although passage... Read more
Improve Quality (And Meet Reporting Requirements) Or Pay The Price
SNFs, IRFs, LTCHs: Get set for a major reimbursement revamp next year. It’s that... Read more
ICD-10 Transition:
Eliminate Common Coding Practices In ICD-10
Hint: Missing this could make your code choice invalid. Are you on track to begin usin... Read more
Industry Notes:
Therapy Cap Elimination Almost Made It Into Doc Fix
Providers of Part B therapy, including home health agencies who furnish the service in p... Read more
Outpatient Outlook:
Taste Sweet Victory With SGR Fix, Therapy Cap Repeal Not So Much
Experts fear therapy cap repeal lost its best chance to pass. The April 1, 2015 deadli... Read more
Your Early April Medicare Payments May Be OK
CMS lends a hand while Congress works out solution. Panicking about your Medicare clai... Read more
What Is MIPS?
Included in the Medicare and CHIP Reauthorization Act, legislators introduced a new syst... Read more
Home Health Therapy:
Robust Therapy Documentation Could Make Or Break Claims
Tip: Protect against subsequent reviews by documenting medical necessity carefully. Ar... Read more
HIPAA Breaches:
Protect Against Data Breaches In 5 Steps
Warning: Learn from this sophisticated cyberattack. If you think you have your patient... Read more
Industry Notes:
Here's Your Chance To Give Your Two Cents
The Department of Health and Human Services (HHS) has good news for you. It debuted the ... Read more
Industry Notes:
Glitch May Short HHAs For Therapy Visits Furnished
A claims glitch means you may not be getting your full reimbursement for therapy, but a ... Read more
Industry Notes:
Don't Forget The Legible Signature Rule
If your claims are lacking a legible signature, you’ll also find a lack of income.... Read more
Reader Questions:
When Is EOT Required?
Question: The resident’s last therapy date was Feb. 21. Medicare ended on Feb... Read more
Reader Questions:
Know When An Unscheduled OMRA Is Okay
Question: The resident’s 60-day MDS has an Assessment Reference Date (ARD) of Feb.... Read more
Reader Questions:
Get A Therapy V-Code Refresher For SNFs And HHAs
Question: I’ve just relocated to a SNF setting from a hospital outpatient the... Read more
Reader Questions:
Check What a Tech May Or May Not Document
Question: We are currently building out our EMR content and the following questions came... Read more
Payment Reform:
Say Good-bye to Volume and Hello to Value
Your 2018 payments could see a -6% impact or more if you aren’t participating in P... Read more
Follow 6 Steps To Survive The Return Of Therapy MMRs
Assemble — and prepare — your ADR response team now. The Manual Medical Re... Read more
Learn From The Biggest HIPAA Breach To Date
Tip: You can still have a HIPAA problem, even if no medical information is taken. Are ... Read more
Industry Notes:
Special Funding For Physical Therapist Researchers
Special Funding For Physical Therapist Researchers If you dream of conducting physical... Read more
Affordable Care Act:
Insurance Plans in the Hot Seat Over Habilitation Coverage
SBCs unclear, required benefits missing. Don’t let new Affordable Care Act (ACA)... Read more
Outpatient Outlook:
Catch the Latest Changes in Manual Medical Review Process
Additional documentation requests to have ‘stepped’ approach. As of 2014, ... Read more
Therapy Caps In The Eye Of A Storm
Patients could suffer the most, therapists point out. Therapists and their representat... Read more
Home Health Therapy Audits:
Does Your Documentation Land Your Claims On The Rejection Pile?
Tip: Evade downcodes and denials by watching out for these mistakes. For therapy only ... Read more
Home Health Therapy:
Get Therapists, Nurses On The Same Page Or Risk Reimbursement
Common mistake: Physical therapy and nursing tell two different stories. Unless nursin... Read more
Patient Privacy:
Ignoring Paper Records Could Prove to Be A Costly Mistake
Lesson: Provide proper HIPAA training to all employees and institute proper HIPAA polici... Read more
Practice Pointers:
4 Steps to Solid Billing for Personal Injury Patients
Don’t leave your payment to chance. Got personal injury patients knocking at you... Read more
SNF Reimbursement:
Hold On To Those Precious Maintenance Therapy Dollars
With improvement standard’s dark cloud scattered, bask in the need based sun. Me... Read more
Practice Pointers:
4 Things Every Rehab Manager Can Do to Prepare for RACs
It’s never too late to improve your billing and documentation practices. Provide... Read more
HIPAA Risk Assessment:
Update Your Software Or Pay The Price
Tip: Tailor security policies to the actual information security infrastructure you have... Read more
Industry Notes:
F2F, POC Problems Plague High-Therapy Claims
Face-to-face, plan of care and OASIS requirements continue to torpedo high-therapy claim... Read more
Outpatient Outlook:
Get Your Year-End Medicare Regulatory Roundup
Physician Fee Schedule cuts, therapy cap exceptions await congressional action, as usual... Read more
Practice Pointers:
Know 2015 PQRS Requirements Like the Back of Your Hand
Start now and avoid penalties later. If you’re a PT, OT, or SLP in private pract... Read more
Prevent Potentially Disastrous Reimbursement Issues
Changes to intensity of therapy crucial when deciding on RUG re-classification. Master... Read more
Pulmonary Rehab:
Dodge these Pitfalls to Remain On Top with Pulmonary Rehab Reimbursement
Knowing when to use G codes critical. Billing a pulmonary rehabilitation (PR) program ... Read more
Industry Notes:
CMS Clarification on Use of New Modifiers
The Centers for Medicare & Medicaid Services (CMS) debuted four new modifiers to be ... Read more