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Medicare rules - Nurse Practitioner (NP) Services
Effective for services rendered after January 1, 1998, any individual who is participating under the Medicare program as a nurse practitioner (NP) for the first time ever, may have his or her...
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Clinical Nurse Specialist (CNS) Services
Effective for services rendered after January 1, 1998, any individual who is participating under the Medicare program as a clinical nurse specialist (CNS) for the first time ever, may have his or her...
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Definition - Active participation, Assessment, certification, clinician and...
ACTIVE PARTICIPATION of the clinician in treatment means that the clinician personally furnishes in its entirety at least 1 billable service on at least 1 day of treatment.ASSESSMENT is separate from...
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what is EPISODE, Evaluation, and interval in outpatient therapy billing
The EPISODE of Outpatient Therapy – For the purposes of therapy policy, an outpatient therapy episode is defined as the period of time, in calendar days, from the first day the patient is under the...
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who is NPP, physician, patient, provider and qualified professional - definition
NONPHYSICIAN PRACTITIONERS (NPP) means physician assistants, clinical nurse specialists, and nurse practitioners, who may, if state and local laws permit it, and when appropriate rules are followed,...
View ArticleMedicare update on Importance of Preparing/Maintaining Legible Medical Records
Many claim denials occur because the providers or suppliers do not submit sufficient documentation to support the service or supply billed. Frequently, this documentation is insufficient to demonstrate...
View ArticleInitial Certification of Plan on therapy services
The physician’s/NPP’s certification of the plan (with or without an order) satisfies all of the certification requirements noted above in §220.1 for the duration of the plan of care, or 90 calendar...
View ArticleWhat is Rehabilitative Therapy
Description of Rehabilitative Therapy.The concept of rehabilitative therapy includes recovery or improvement in function and, when possible, restoration to a previous level of health and well-being....
View ArticleWhat is skilled therapy
Skilled Therapy.Rehabilitative therapy occurs when the skills of a therapist, (See definition of therapist in section 220 of this chapter) are necessary to safely and effectively furnish a recognized...
View ArticleDocumentation Requirements for Therapy Services
Documentation RequiredList of required documentation. These types of documentation of therapy services are expected to be submitted in response to any requests for documentation, unless the contractor...
View ArticleWho is Qualified Speech-Language Pathologist Defined
A qualified speech-language pathologist for program coverage purposes meets one of the following requirements:• The education and experience requirements for a Certificate of Clinical Competence in...
View Articlewhat is Dysphagia in pathology service
Dysphagia, or difficulty in swallowing, can cause food to enter the airway, resulting in coughing, choking, pulmonary problems, aspiration or inadequate nutrition and hydration with resultant weight...
View ArticleChiropractic Services - General
The term “physician” under Part B includes a chiropractor who meets the specified qualifying requirements.Effective for claims with dates of services on or after January 1, 2000, an x-ray is not...
View ArticleOffice visit CPT, E&M code fee schedule - Florida Medicare
CPT Code Medicare Allowed Amount99201 Office visit new level 1 $43.8099202 Office visit new level 2 $74.5399203 Office visit new level 3 $109.0699204 Office visit new level 4 $166.6399205 Office visit...
View ArticleSubluxation May Be Demonstrated by X-Ray or Physician’s Exam
Subluxation is defined as a motion segment, in which alignment, movement integrity, and/or physiological function of the spine are altered although contact between joint surfaces remains intact.A...
View ArticleDocumentation Requirements: chiropractice Initial Visit
The following documentation requirements apply whether the subluxation is demonstrated by x-ray or by physical examination:1. History as stated above.2. Description of the present illness...
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Wellcare – Flu Caccination Season 2012-2013This communication provides you with important information regarding the 2012-2013 flu season (September 1,2012 through April 15,2013)and Wellcare/HealthEase...
View ArticleNecessity for chiropractic Treatment
The patient must have a significant health problem in the form of a neuromusculoskeletal condition necessitating treatment, and the manipulative services rendered must have a direct therapeutic...
View ArticleDefinition of Ambulatory Surgical Center (ASC)
An ASC for purposes of this benefit is a distinct entity that operates exclusively for the purpose of furnishing outpatient surgical services to patients. It enters into an agreement with CMS to do so....
View ArticleMedicare ASC covered services
Examples of covered ASC facility services include:Nursing Services, Services of Technical Personnel, and Other Related ServicesThese include all services in connection with covered procedures furnished...
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