Medicare

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.

Sustainable Growth Rate

What is the Sustainable Growth Rate (SGR) and How Does It Affect Medicare Payments?

The Balanced Budget Act of 1997 included a provision to balance the Medicare budget by adjusting the dollar conversion factor by a complicated formula based on the following four items:

Telehealth Psychiatric Service (Resource 283)

Telehealth (also known as telemedicine) is playing an ever increasing roll in the reimbursement process. Internet services continue to expand and many insurance payers/providers are now covering (paying for) telehealth services. Telepsychiatry (providing behavioral health services in a telehealth environment) has been highly successful because video conferencing makes providing psych services as realitvely simply and inexpensive process.

Are you ready for testing?  CMS released  providers, suppliers, billing companies, and clearinghouses are welcome to submit acknowledgement test claims anytime up to the October 1, 2015, implementation date. In addition, CMS will be highlighting this testing y offering three separate weeks of ICD-10 acknowledgement testing. These special acknowledgement testing weeks give submitters access to real-time help desk support and allows CMS to analyze testing data. Registration is not required for these virtual events.

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