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Why Do Medicare Administrative Contractors Deny for “Skills of Therapist Not Supported”?

Maybe you have been involved in a Training, Probe and Educate (TPE) audit for your Medicare Part B claims this year. If so, you are not alone. The Medicare Administrative Contractors (MACs) have been focusing on Physical Therapy (PT), Occupational Therapy (OT) and Speech Language Pathology (SLP) documentation and the TPE is a common way to capture the attention of providers. The Centers for Medicare & Medicaid Services (CMS) TPE provides a full explanation of…

Inpatient Rehabilitation Review Choice Demonstration Project: How Is It Going?

The Review Choice Demonstration (RCD) project for Inpatient Rehabilitation Facilities (IRF) seemed like a pipe dream when the Centers for Medicare & Medicaid Services (CMS) started talking about it even before the Pandemic. But, now it is in full swing in Alabama and Pennsylvania. Texas and California are slated to be next in the roll out.  If you are listed and bill as an Inpatient Rehabilitation Facility (IRF) or an Inpatient Rehabilitation Unit (IRU) in Pennsylvania,…

What Impact Does the 2025 Proposed Rule Have If You Provide PT and OT Treatments?

The 2025 Proposed Rule was released on July 10, 2024. There will be significant changes in operations practice for Physical Therapy (PT) and Occupational Therapy (OT).  There will need to be modifications to the Medicare Benefit Policy Manual (MBPM) Section 220, if the rule is finalized in November 2024, to be effective 1/1/2025. The press release for the 2025 Proposed Rule provides specifics. Here are two of the therapy changes that were outlined in the proposed rule:…