Medicare’s latest clarification of Manual Medical Review Well, Medicare has been busy. When CMS decided to keep the Manual Medical Review process for 2013, several questions were left open for clarification. Namely: • Since 2012 was a mad scramble of reviews and appeals, how will the approval process work for 2013? • Who will conduct the review, given that MAC’s are not staffed to manage this? • Is the patient liable for services above the
Read More...What to Expect Out of a Physical Therapy EMR or Practice Management System Now that we are 2 months into 2013, the big rush to PQRS adoption for Clinicient users is largely behind us. Still, I continue to hear a lot of questions about PQRS in discussion groups and from therapists evaluating EMR and Practice Management systems. Here are some of my thoughts. What is PQRS? The Physician Quality Reporting System (PQRS) is a way
Read More...In a previous blog post, I summarized the new functional G-codes and what we can expect in 2013. This article will summarize how they work, how you report the measures and what is critical to remember. CMS has defined categories of functional limitation that address “activity limitations” and “participation restrictions”. They have assigned specific G-Codes for each category. The categories for 2013 are: Mobility: Walking & Moving Around Changing and Maintaining Body Position Carrying, Moving
Read More...Every holiday season is a blur for me because it coincides with the annual end of year “scramble to support new CMS policies” event. But this year really takes the cake. With the dust barely settled on the phasing of Manual Medical Review and my head still spinning from the recent Medpac recommendations, it is already time to turn my attention to the new claims based data-collection strategy, popularly known as the new G-Codes. Before
Read More...As we continue to roll out product changes to help our customers manage CMS’ ever changing policies, I thought this article in the New York Times emphasized what nearly every new policy is about. CMS is very serious about getting their arms around fraud. And, poor billing practices and mistakes in documentation are equivalent to fraud. For CMS, EHR adoption is desired, but not if it is used to systematically ‘upcode’ the level or quantity of
Read More...Medicare Cap adds a new wrinkle Neatly tucked in the Middle Class Tax Relief and Job Creation Act of 2012 was the extension for 2012 of the Medicare therapy cap. It is an extension that comes with a whopper of a wrinkle. Beginning October 1, 2012, CMS is “phasing-in” a Manual Medical Review of all claims for patients who have received more than $3700 worth of benefits in the calendar year 2012. At the same
Read More...Back to School season means it is CMS change season as well. It must be a busy time to work at CMS. Over the next 12 months several changes included in the Middle Class Tax Relief and Job Creation Act of 2012 will begin to impact providers of outpatient rehab services. Some changes will cause significant effort by all involved; others are minor refinements to the existing Therapy Cap process. In a few linked articles,
Read More...The long expected news of a delay to the implementation date for ICD-10 became a little more official this week. HHS has formally announced a proposed rule change that would effectively slip the effective date from Oct. 1, 2013 to Oct 1, 2014. ICD-10 promises to improve electronic communication by adding specificity to both diagnosis codes and CPT codes. The codes are fundamentally different because they carry within the code additional information that characterizes anatomic
Read More...You may have heard that CMS has announced a 90 day period of “enforcement discretion” for compliance with the new HIPAA Transaction standards. Here is a link to the announcement: CMS 5010 Statement Their rationale for the delay is, “…testing between some covered entities and their trading partners has not yet reached a threshold whereby a majority of covered entities would be able to be in compliance by Sunday, January 1, 2012.” What does
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