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...
Don’t Be Afraid of the “S” Word: We’re all in Sales I was talking with @Jerry_DurhamPT at the APTA Combined Sections meeting in San Diego, CA in January and we were discussing the fact that most physical therapists wouldn’t see themselves as salespeople. Jerry recommended a book to me by Daniel Pink called To Sell is Human, which I just started reading. The basic premise of the book is (pretty evident from the title) that we
Read More...
The therapy rehabilitation community has been judicious in determining the best time to activate our grassroots efforts regarding the therapy cap…and the time is NOW! Congress has been very clear: it will not take action without input from constituents. Your representatives must hear from you and your patients. Please consider sending at least 1 advocacy e-mail or making 1 advocacy phone call this week. This is the greatest opportunity for our members to influence Congress and remind them
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 I indicated in some prior posts linked at the bottom of this post, we have the attention of Medicare. Under the Microscope To review, the Medicare Payment Advisory Commission (MedPAC) has made it clear that therapy services are going to be under close scrutiny. Using physicians as gatekeepers and using an annual cap with an automatic exceptions process has not changed therapy utilization in any meaningful way. Put more simply, from MedPAC’s perspective, Medicare doesn’t
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...Centers for Medicare & Medicaid Services Special Open Door Forum: Manual Medical Review of Therapy Claims Wednesday, September 5, 2012 2:00pm – 3:30pm Eastern Time Conference Call Only The purpose of this Special Open Door Forum (ODF) is to provide an opportunity for providers to ask questions about the mandated manual medical review of therapy services from October 1-December 31, 2012 that was enacted by the Middle Class Tax Relief and Job Creation Act of 2012.During
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...
