Effective Jan 1, 2023, MaineCare implemented a new “rounding” rule for billing timed codes. In order to bill for a 15-minute timed code, you must perform the intervention for 80% of that 15 minutes (12 minutes). (Old rule allowed you to bill if you provided the treatment for more than 50% of the time). Please […]
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Can a cash practice see a workers’ compensation patient? Maybe. State laws govern workers’ compensation. If your state laws allow the employee to choose their heath care providers, versus allowing the employer to direct what providers see their injured workers, then you should be able to see the patient. State work comp laws may
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AIM has just published new “Clinical Appropriateness Guidelines” for PT, OT and ST that will be effective Oct. 1, 2020. Anthem in-network providers will be required to follow these guidelines, so you should review them in advance of Oct. 1. Contact Gwen if you have any questions or concerns about them.
New AIM Clinical Appropriateness Guidelines, effective Oct. 1, 2020 Read More »
We have reliable information that the following health plans DO NOT require AIM pre-authorization in Maine: Maine Health Maine Teacher’s Association (MEA Trust) CMP Federal BCBS AIM’s message when you try to obtain pre-auth for these plans tells you to call Anthem. You do not need to do this. I recommend, however, that you ask
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CLIENT ALERT Some Maine PT providers have received a letter from Anthem dated August 28, 2019 stating they did a review of claims between 2/1/2018 and 1/31/2019 and their utilization of CPT code 97110 was “outside the average utilization for your specialty.” The letter appears to be a template form. It is not even properly
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Advice on Superbills When you agree to see a Medicare beneficiary who has elected to pay you cash instead of seeing a Medicare enrolled provider you are accepting some risk that the patient may try to submit your receipts to Medicare for reimbursement or to obtain a denial for a Medicare Supplemental Plan. If the patient
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Member Webinar In this webinar Gwen Simons discusses the standard of care for documentation and what is essential to document to support charges regardless of whether the PT is in or out-of-network. https://vimeo.com/347596338 Resources Slides_Documentation Essentials
Documentation Essentials, Speaker: Gwen Simons Read More »
Member Webinar What are the proposals and how might they affect your practice? In this webinar we discuss the various Medicare For All proposals that are currently being discussed. Some eliminate private insurance and some only provide Medicare as a “public option.” The impact on providers varies with each proposal https://vimeo.com/336213667 Resources Medicare for All_slides_2019-03-20
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Maine Practice Management Network Members: If you received the attached letter recently (or receive one in the future) from Prime Health Services, Inc. asking you to sign an Addendum to your Participation Agreement for workers’ compensation, it is because Prime thinks you have a contract with them to take a discount on your workers’ compensation
Prime Health Services WC Addendum Read More »
Many thanks to Mary Kroth-Brunet at Back in Motion Physical Therapy for speaking briefly at our Annual Client meeting on Jan. 26 about the new PT Eval codes. You can access Mary’s “cheat sheet” here. Mary will provide more in-depth instruction on how to use these codes at the February 15th Practice Management Network webinar
