FearonLevine.com - The Rehabilitation Resources You Need – When You Need Them!http://www.fearonlevine.com/rss.aspxThe latest headlines and Articles from FearonLevine.com.(c) 2012, FearonLevine.com. All rights reserved.5Version 5010 Enforcement Discretion Period Ends in 38 daysThe deadline for all HIPAA-covered entities to upgrade to Version 5010 electronic standards was January 1, 2012. However, CMS initiated an enforcement discretion per...http://www.fearonlevine.com/BreakingNews.aspx?id=E3F46BE1-659D-45B1-85C3-D0C0CF086C965/25/2012 12:00:00 AMTotal Hip and Knee Joint Replacement: Understanding Documentation Requirements to Support Medical Necessity – Novitas Solutions Inc.Novitas Solutions (formerly Highmark Medicare Solutions) describes the detailed documentation requirements needed to support an inpatient admission for total hip or knee replacement. The documentation requirements include a pre-operative trial of physical therapy with very specific details about the patient's pain and functional status. Novitas is investigating these inpatient admissions as part of their Comprehensive Error Rate Testing (CERT) program./Resource.aspx?id=C41583E6-A549-454A-87DC-4834399D3E8D5/17/2012 12:00:00 AMHow the Common Working File (CWF) Impacts Claims: Noridian Administrative Services (NAS)Noridian Administrative Services, Medicare's Jurisdiction D Durable Medical Equipment (DME) contractor, explains the purpose of a Common Working File (CWF) and how it is accessible to providers to check on the status of claims as well as the dollar amount accrued towards the therapy cap./Resource.aspx?id=62E02CD4-A7C5-46B6-AF66-8F53D81303815/17/2012 12:00:00 AMCNA/HPSO: Physical Therapy Claims StudyCNA, a major insurer of physical therapists, released a report of liability claims between December 1, 1993 and March 31, 2006 which includes recommendations for risk management. This is an important study for anyone interested in direct access and practice management issues./Resource.aspx?id=B0546547-D6E1-49E8-90A1-82BAEED0DBE45/14/2012 12:00:00 AMMedicare Fraud Strike Force Arrests 107 Individuals for Over $450 Million in False BillingOn May 2, 2012, the Department of Justice (DOJ) announced the arrest of over 100 individuals in seven cities for over $450 million in false billing to the Medicare program./Resource.aspx?id=74B478BC-AC8E-45EB-B149-A9B3242C1A465/14/2012 12:00:00 AMSubmit Medicare Provider Application Enrollments Sooner!CMS has announced that providers and suppliers can now submit their enrollment applications 30 days sooner. CMS-855 enrollment applications and Internet-based PECOS ...http://www.fearonlevine.com/BreakingNews.aspx?id=37A523C2-43AD-4253-BB9E-3C35678DACCC5/11/2012 12:00:00 AMRevision of Financial Limitations for Outpatient Therapy Services - Transmittal 2457: CMSThe Centers for Medicare and Medicaid Services (CMS) has published guidance pertaining to the revision of financial limitations for outpatient therapy services effective October 1, 2012. Most notably, outpatient therapy delivered in most hospitals will be subject to the therapy cap beginning October 1, 2012. Also, contractors will perform manual medical reviews for physical therapy and speech language pathology services combined in excess of $3700. Manual review of outpatient occupational therapy claims in excess of $3700 will be reviewed separately./Resource.aspx?id=6C8B1002-9979-4BB9-AB4C-0237C4A598BC5/10/2012 12:00:00 AMRevision of Financial Limitations for Outpatient Therapy Services - Transmittal 2457: CMSThe Middle Class Tax Relief and Job Creation Act of 2012 (MCTRJCA) allows for extension of the therapy cap through December 31, 2012. The Act permits the exceptions ...http://www.fearonlevine.com/BreakingNews.aspx?id=34E515C6-36F3-4CE0-ABC1-67C010B357735/10/2012 12:00:00 AMMedicare Fraud Strike Force Arrests 107 Individuals for Over $450 Million in False BillingThe government announced on May 2, 2012 that a Medicare Strike Force arrested 107 individuals in seven cities involved in false billing to the Medicare program. The ...http://www.fearonlevine.com/BreakingNews.aspx?id=B77F02AF-B45C-4663-89C4-3373B243BFDE5/4/2012 12:00:00 AM"Anatomy of a Fraud Bust: From Investigation to Conviction”: DHHS OIGTestimony by the Inspector General of the Department of Health and Human Services (DHHS) on April 24, 2012 describes the increasingly effective work of the Health Care Fraud Prevention and Enforcement Action Team (HEAT) Strike Forces in fighting health care fraud./Resource.aspx?id=8B5D4A95-2410-4279-9EDF-6CB69DE1079F5/3/2012 12:00:00 AMYour Guide to Understanding the Medicare Program – A Resource for Consumers: KFFThe Kaiser Family Foundation (KFF) has published a resource for consumers explaining all components of the Medicare program. Providers may consider offering this resource to patients who are having difficulty understanding their Medicare benefits./Resource.aspx?id=3FFF4624-3AEC-437D-8635-93194EB206135/3/2012 12:00:00 AMUpcoming Chat Session : May 15, 2012 - Coding, Documentation, and CompliancePresenter(s): Helene Fearon, PT and Steve Levine, PT, DPT, MSHA<br />Premier Subscriber Chat Session: Live interactive open forum session where you can ask you questions related to coding, documentation, compliance, and practice management and get answers directly from Helene Fearon, PT and Steve Levine, PT, DPT, MSHA.http://www.fearonlevine.com/Secure/ChatSessionListings.aspx?id=D81A85C5-5D19-4584-853D-BD66A48E1D275/1/2012 12:00:00 AMHospital Inpatient Prospective Payment System (IPPS) Proposed Rule for FY 2013: CMSOn April 24, 2012, the Centers for Medicare and Medicaid Services (CMS) issued the proposed rule for the Hospital Inpatient Prospective Payment System (IPPS) and long term care hospitals paid under the Long Term Care Hospital Prospective Payment System (PPS) for FY 2013. The proposed rule would generally apply to discharges on or after October 1, 2012. /Resource.aspx?id=2A39F651-71A9-4C0F-A988-42E0ABF07C744/30/2012 12:00:00 AMFair Physical Therapy Copays: APTA and Kaiser Health NewsInitiatives in multiple states are aimed at limiting patient copays associated with physical, speech, and occupational therapy./Resource.aspx?id=2E7A5582-6202-47F2-B5F7-8271BC09A6854/30/2012 12:00:00 AMOwners and Operators of Physical Therapy Clinics Charged in Multi- Million Dollar Health Care Fraud ConspiracyThe Department of Justice has announced the unsealing of a thirty-count indictment charging Luis Duluc (51, formerly of Weston, Florida), and Margarita Grishkoff (57...http://www.fearonlevine.com/BreakingNews.aspx?id=AC4667F7-B70B-4C37-9B69-4583F36C98224/27/2012 12:00:00 AMSimplification of National Correct Coding Initiative (NCCI): April 2012: CMSBeginning April 1, 2012, the Centers for Medicare and Medicaid Services (CMS) will initiate combined publication of both of the National Correct Coding Initiative (NCCI) files./Resource.aspx?id=26C58F4F-A388-4CAF-A84F-0477164C465C4/24/2012 12:00:00 AMWidespread Prepayment Review for Manual Wheelchair Bases K0001, K003, K0004: Noridian Administrative Services (NAS)Jurisdiction D Durable Medical Equipment (DME) Medicare Administrative Contractor (MAC) is conducting widespread prepayment complex medical review of manual wheelchair bases (K0001, K0003, K0004) and in the first quarter of 2012 found an extremely high error payment rate of 88 percent or more for all three bases. /Resource.aspx?id=171F1D0C-4C97-4506-88A8-40A09C6EB52B4/24/2012 12:00:00 AM2010 Physical Quality Reporting System (PQRS) Reporting Gains: CMSThe 2010 reporting data from the Physician Quality Reporting System (PQRS) show an increase in the number of eligible providers that successfully reported quality measures by both the claims and registry methods./Resource.aspx?id=C2C036AC-5E93-47A3-AAFD-A01093C8A4E54/24/2012 12:00:00 AMCompetitive Bidding Update -Saving Money for Taxpayers and People with Medicare: CMSThe Medicare program saved $202 million in its first year of the Competitive Bidding Program in nine metropolitan statistical areas (MSAs), a reduction of 42 percent in costs./Resource.aspx?id=7DBDBA29-6824-4E78-B130-BBAAD16D45934/24/2012 12:00:00 AMMedicare Learning Network Compliance Resources: CMSMany excellent resources on compliance are available on the Medicare Learning Network (MLN) Compliance website./Resource.aspx?id=3785A6E6-FE48-4281-A6AA-AAB20BE957BF4/23/2012 12:00:00 AMGuidance for Correct Claims Submission When Secondary Payers are Involved: CMSThe Centers for Medicare and Medicaid Services (CMS) provides guidance on proper office procedures when managing claims that include secondary payers./Resource.aspx?id=4A6379C7-22EF-46EA-8134-CB99AF40FB874/23/2012 12:00:00 AMRehabilitation Measures Database: CROR and RICA multidisciplinary group of professionals at the Rehabilitation Institute of Chicago Center for Rehabilitation Outcomes Research (CROR) and the Northwestern University Feinberg School of Medicine are developing a website of outcome measurement tools pertinent to rehabilitation practice and research./Resource.aspx?id=FEBA44F5-6DE0-4A65-9C5D-E822436B4A964/21/2012 12:00:00 AMExcessive Use of the KX Modifier: First Coast Service Options (FCSO)First Coast Service Options (FCSO), the Medicare Administrative Contractor (MAC) for Florida, has published important information regarding excessive use of the KX Modifier. /Resource.aspx?id=F5E36758-D488-4EBA-BF00-CB85CE1F51D54/20/2012 12:00:00 AMKX Modifier FAQs: First Coast Service Options (FCSO)First Coast Service Options (FSCO), the Medicare Administrative Contractor (MAC), has posted a series of frequently asked questions (FAQs) pertaining to use of the KX modifier and other therapy issues./Resource.aspx?id=D99E50AE-7853-472E-A57B-E3B3D03E615D4/20/2012 12:00:00 AMDallas-based Tenet Healthcare Pays More Than $42 Million to Settle Allegations of Improperly Billing Medicare for Inpatient Rehabilitation Facility ServicesTenet Healthcare Corporation has agreed to pay the United States $42.75 million to settle allegations that it violated the False Claims Act by overbilling the federa...http://www.fearonlevine.com/BreakingNews.aspx?id=93BB8D17-86A6-4F7B-B5EF-1F9968CE5BCA4/18/2012 12:00:00 AM