FY 2014 SNF PPS MDS 3.0 Policy Changes
Although our website and email addresses have changed…. we continue to be the Premier provider for all your therapy needs and remain committed to making a difference every day!
Visit us at: www.embracepremier.com
Embrace the Difference!
Call for a consultation to see if you are ready for the future at (724) 417- 8840.
As you know, effective July 1, 2013 Functional Reporting applies to all claims furnished under the Medicare Part B outpatient therapy benefit and to Physical Therapy (PT), Occupational Therapy (OT), and Speech- Language Pathology (SLP) services furnished under the Comprehensive Outpatient Rehabilitation Facility (CORF) benefit CMS offers a Quick Reference Guide that summarizes this requirement.
Here is the link to access:
CGS Ask the Contractor (ACT) session- Top Denial Reasons for medical Review January-March 2013.
ACT was held on August 14, 2013. The replay is available until August 20, 2014 by calling 1-888-203-1112, Pass code 8978890. The ACT discussed CGS News article of June 28, 2013 that listed top denials codes, here is the link:
5DOWN – Medical Review Downcode
5D504/5H504 – Information provided does not support the medical necessity for this service
5D501/5H501 – Billed in error 5D507/5H507 – SNF MDS is not in the National Repository
5H508 – Benefits exhausted on SNF claim for services subject to benefit period determination
56900 – Medical records not received 5D171/5H171 – The requirements for a short stay are not met
**** CGS stressed the importance of internal audits as an effective tool to save time and money when dealing with ADRs ****
Call to hear about Premier’s “Audit Score Card” which gives an interdisciplinary documentation report card!
“What information should it contain?”
“How is it different from treatment encounter notes?” For more see:
Medicare FAQ – Questions regarding Therapy Progress Report/Treatment Encounter Notes near top for most frequently asked. Suggests some therapy providers are unsure of the regulation as focus turns on Progress Note reporting for Functional Limitation G codes. Below are links to the questions as well as the LCD for Outpatient Physical and Occupational Therapy.
For information about Premier Therapy’s comprehensive education and audit program to ensure 100% compliance with CMS regulations, please contact Scott Slipko at 724-417-8840.
CMS Frequently Asked Questions
Local Coverage Determination (LCD): Outpatient Physical and Occupational Therapy Services (L31886)