Category Archives: Outpatient Rehab

Procrastination seems like a worthwhile event if you are one of those persons that performs best under stress and against all odds meets the necessary deadline. However, if you are talking about the now infamous therapy G-Codes and impairment modifiers, you may have missed a ‘soft’ deadline without even noticing. As an optimist you believe that if you meet the ‘hard’…
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For some time now, several of my colleagues and I have been discussing the transformation of healthcare and how transparency, pay for performance, quality initiatives and the like will impact the way we provide healthcare for ever more.  Just this week, CMS made headway toward pushing operational information into the hands of anyone wishing to find it! The CMS News Release…
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On February 28 we issued a blog that discussed Medicare’s interim solution to providing outpatient therapy documentation review for patients that had neared or exceeded the 2013 threshold of therapy services CAP allowances. Going forward, with both the interim solution and the updated guidance, payment will hinge upon your waiting for the Fiscal Intermediary (FI/MAC) to begin the review process rather than the…
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Each year, regulatory ‘junkies’ like myself look forward to the spring AMRPA meeting because their sessions are geared to prepare facilities to meet with legislators to discuss and influence judgements through testimony related to their level of service and how they see proposed mandates affecting access to care and reimbursement. Invited guests have firsthand knowledge of everything we need to be concerned about in today’s ever-changing regulatory white…
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Just when we thought we didn’t really have a solution for the Therapy Caps Manual Medical Review, the APTA released a bulletin recently that states CMS has decided how it will manage the 2013 process previously referred to as Manual Medical Review to approve therapy services beyond the Cap. From Oct. 1, 2012 until Dec. 31, 2012, Manual Medical Review required seeking approval…
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Late last week Amit M (LinkedIn member), posted that a bill to repeal outpatient therapy caps had been discussed on Valentines Day. Wouldn’t that beat all boxed chocolates and a few dozen roses when it comes to gifts on a beloved gift card holiday? I immediately went to the Government Printing Office and searched for all discussions that occurred in the…
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Investing in information systems is a costly endeavor and everyone involved asks the same question, “What will the return on investment be?” It’s no different in healthcare, and in the world of meaningful use, ROI is not discussed in terms of dollars but rather value to the organization in how these systems improve their ability to deliver on expectations or…
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Earlier this week, CMS clarified that outpatient rehabilitation therapy benefits paid while receiving care at a critical access hospital will apply toward the therapy cap; however, the CAH itself is not required to utilize the therapy cap exception (KX modifier) or manual medical review process. As it pertains to the benefits paid, the physician fee schedule will be used to…
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With the first read of Pam Arlotto’s ”Rethinking Return on Investment: The Challenge of Accountable Meaningful Use,” healthcare providers are acquainted with what it will take to transform existing care delivery organizations to patient-centric, high quality, cost-efficient organizations to compete under the proposed Affordable Care Legislation.  Managing value will require a realignment of organizational culture and operations to achieve success. Management of…
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“To improve the efficiency and effectiveness of the health care system, the Health Insurance Portability and Accountability Act of 1996 (HIPAA), Public Law 104-191, included Administrative Simplification provisions,” reported on the Health and Human Services website. In warped speed, let me refresh the last 17 years and what has been accomplished with the various publications and rules set toward this Administrative Simplification…
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