While CMS tries to figure out how to proceed with the manual medical review process, we continue to track our caps and apply our modifiers. In the meantime, has anyone noticed how our typical Medicare...
Palliative possibilities: Therein lies the rub
By
Shelly Mesure, MS, OTR/L
Apr 22, 2014
When a patient is referred to therapy, and they are receiving hospice care, then therapy needs to seek permission from the hospice company to provide any treatment. Hospice is required to reimburse the...
CMS not saying much about a payment deal that could be a game changer
By
John O'Connor
Jul 08, 2013
In recent years, many skilled care operators have nervously watched the Centers for Medicare & Medicaid Services reduce and sometimes eliminate payments for physical, occupational and speech therapy services....
Entitlement or over utilization?
By
Shelly Mesure, MS, OTR/L
Oct 07, 2014
Many of our therapy patients are medically complex and we, unfortunately, are not able to predict the future, as it sometimes seems that regulators want us to do.
Pay for performance, medical necessity and Jimmo
By
Shelly Mesure, MS, OTR/L
Jun 04, 2014
Why would anyone mention value-based reimbursement, medical necessity and the Jimmo lawsuit in the same sentence? I feel they are all related, but it will be difficult to find the perfect balancing act...
The G-codes are here for payment claims — ready or not
By
Shelly Mesure, MS, OTR/L
May 23, 2013
Effective July 1, the Centers for Medicare & Medicaid Services will begin rejecting claims received for Medicare Part B patients that do not include the new requirement of G-coding. That really means providers...
Shamelessly invoice at your own risk
By
John O'Connor
Mar 22, 2013
Here’s the good news for providers: new analytics are making it possible to understand and bill your care in ways that would have been impossible just a few years ago. Here’s the bad news:...
When LTC leaders delegate accountability
By
John O'Connor
Nov 19, 2012
What happens when delegation without accountability takes place? We saw a good example last week, when the Office of Inspector General released a damning report about excessive Medicare charges from nursing...
Dehydration: Therapy should help fight it
By
Shelly Mesure, MS, OTR/L
Jul 15, 2014
The elderly are very vulnerable to dehydration and more than just the nursing staff have to be concerned about it. Not keeping an eye on appropriate hydration can cause a variety of serious problems.
Are you prepared? 5 questions you need to know the answers to
By
Shelly Mesure, MS, OTR/L
Aug 27, 2013
With all the recent regulatory changes that have come down the line, or are about to, we developed a simple five-question survey that each provider had to ask every therapy employee. If you can develop...