CarePoint Therapy Management Blog

A contract therapy client in New York asked the following question …  “If a patient exceeds the Medicare Part B therapy cap, is it CMS’s expectation that a KX modifier should be assigned to G codes as well?  I know we need to assign KX modifiers to the entire month’s billing regardless of when the actual therapy cap was exceeded during that month. However, according to CMS KX modifiers are not needed for the G codes?  Can you point me to the documentation that supports this?”

Reporting Distinct Calendar Days of Therapy …  In the May 6, 2013 Federal Register page 26465, CMS clarifies that the Rehab Medium was always intended to be 5 distinct calendar days.  As set forth in the 2010 final rule (74 FR 40389), to be classified into the Medium Rehab category under RUG III or RUG IV, the resident must receive 5 days any combination of 3 rehabilitation disciplines.  The CMS clarification in the May 2013 Federal Register and July 2013 Final Rule is as follows …

A contract therapy client in Ohio writes …  In reviewing the Medicare Learning Network (“MLN”) Matters revised, the G code for Motor Speech Projected Goal doesn't match the G code listed in CarePoint for that goal. Can you clarify if G9186 as listed in the MLN memorandum or G9157 as listed in CarePoint is the correct code?  I am looking at the most recent MLN memorandum and want our CPT code table in CarePoint to be accurate.

A visitor to our web site asked the following question …  “Is it appropriate for the supervising physical therapist to co-sign a physical therapy assistant's (PTA’s) daily physical therapy treatment charges which have been posted when the supervising physical therapist has no physical means of ensuring that such treatment charges were actually done by the PTA?  I am being asked to do this in my current work place.”

A therapy manager sent us a COT OMRA Management Report to review.  The 7 day observation date was displayed in error because of the misapplication of a skip day.  There is a simple way to prevent this type of error from occurring in the future.

A Contract Therapy Client In Ohio Inquired … “Is the Practice Expense (PE) discount factor of the Multiple Procedure Payment Reduction (MPPR) increasing from 25% to 50% on April 1, 2013?”

Authored By Mary Gennerman, OTR/L

CarePoint Version 9.0 is now available and includes scores of new features that will improve quality control, ensure compliance, maximize reimbursements, and reduce administrative costs.  Selected new features and functions are listed below along with some sample reports.  Some highlights include …

CMS requires functional limitation G-codes with severity/complexity modifiers on all Medicare Part B UB-04 claim forms.  Severity/complexity modifiers must be attached to the new G-codes indicating the patient’s primary functional limitation.  Therapists require simple and effective tools to alert them when these G-codes and modifiers are required, to capture the correct functional area, G-codes, and modifiers for the session; to measure the patient’s progress, and to transmit these codes to CMS as part of the regular UB-04 claims process.  Failure to comply with these new reporting requirements may result in claims denials and the loss of revenue.

CMS will require a functional limitation G-code with a severity/complexity modifier for that limitation on all Medicare Part B claim forms beginning on January 1, 2013.  These codes and modifiers must be included on the claim form and in the patient’s documentation.  Testing of these codes and modifiers will begin on January 1, 2013 with final implementation due on July 1, 2013.  Indicators of levels of assistance used previously will no longer be accepted to support patient documentation.  If a provider continues to use such indicators, then patient scoring must be “cross walked” to the new 7 point impairment scale.