Medicare

ATTENTION In-Patient Hospitals

CMS has announced a settlement request to Inpatient hospitals for claims in appeal status! Due to the unprecedented growth in claim appeals the demand continues to exceed Medicare’s available resources. CMS has made an offer in hopes of quickly reducing inpatient status claims currently pending in the appeals process. CMS is cleaning house and has made this administrative offer to Inpatient hospitals only.

CMS is promoting three National ICD-10 testing Awareness Weeks.  Be sure to get involved early, as they have posted a ONE-TIME notice!  If you are not ready I suggest you get moving. 

To begin with you need to have access to ICD-10 codes, If you don't already have an account with Find-A-Code, Start there!   Find-A-Code gives you the information you need to succeed as well as all the crosswalks you need for ICD-10. 

CLICK HERE for a copy of an ABN Form in Spanish.

Medicare set a Therapy Cap limit for OT (Occupational Therapy) Services in the amt of $1920.00.   With a threshold of $3700. (Be sure to contact your local carrier to verify limits).

CMS launched a new Webcast Series: Road to 10 

Medicare Podiatry Services This article covers routine care of the foot as well as care related to underlying systemic conditions such as metabolic, neurologic or peripheral vascular disease, or injury, ulcers, wounds, and infections.

Medicare Learning Network  (MLN)      https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/SE1113.pdf

CAHs (Critical Access Hospital) need to be aware that the SAD (Self Administered Drugs) regulations do apply to them and that CMS has not indicated that CAHs (Critical Access Hospital) can disregard this rule.

SNF itself must submit all Medicare claims for the services that its residents receive (except for specifically excluded services listed below). CB forSNF resembles the bundling requirement for Inpatient Hospital Services, assigning the facility responsible for the entire package except for certain services thataare specifically excluded. 

 

Medicare has set Annual Therapy Caps at $1920 and they start over Jan 1 of each year.  Medicare  combined the therapy limits SLP (Speech-Language Pathology) and PT (Physical Therapy) for a combined total of $1920.00 in 2014. There is also a Therapy Cap limit for OT (Occupational Therapy) Services of $1920.  These both have a threshold of $3700. (Be sure to contact your local carrier to verify limits).

You need to have a prescription on file and note the correct modifiers on your claim form stating all conditions have been met (for Medicare). I have had better results attaching the prescription to the claim, however it is not required.

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