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There is a great deal of excellent information online for therapists
in private practice. The following websites have been chosen because
they offer free and up to date information covering various aspects of
service delivery for private practitioners.
I. FOR THERAPISTS INVOLVED WITH MEDICARE:
www.cms.hhs.gov
Center for Medicare & Medicaid Services (CMS) homepage
www.cms.hhs.gov/providers
A customized Medicare provider website
www.cms.hhs.gov/QuarterlyProviderUpdates/
• CMS publishes this Update at the beginning of each quarter
to inform the public about the following:
• Regulations and major policies currently under development
during this quarter;
• Regulations and major policies completed or cancelled;
• New/revised manual instructions.
www.cms.hhs.gov/TherapyServices/
This CMS website serves as a guide to direct professionals
to additional resources regarding rehabilitation therapy services,
coverage requirements, payment systems, and points of contact
for further information.
www.cms.hhs.gov/mcd/index_lmrp_bystate.asp
This website lists each state and the LCD contractor that
services that state. Access to contractors can be made through
this website in order to research that website contracted payer's
Local Coverage Decisions, both in draft and final stages. Providers
must abide by the policies and guidelines of the contractor that
processes their claims.
www.cms.hhs.gov/mcd/index_contractorsites.asp
Links to all Medicare Contractor websites
www.cms.hhs.gov/Manuals/IOM/list.asp
CMS Internet-only Manuals (IOMs) are a replica of the Agency's
official record copy. They are CMS' program issuances, day-to-day
operating instructions, policies, and procedures that are based on
statutes, regulations, guidelines, models, and directives. The CMS
program components, providers, contractors, Medicare Advantage
organizations and state survey agencies use the IOMs to administer
CMS programs. They are also a good source of Medicare and Medicaid
information for the general public. www.cms.hhs.gov/BNI/Downloads/CMS20007English.pdf
Notice of Exclusions from Medicare Benefit (NEMB) (PDF Format)
Advanced Beneficiary Notice (ABN). Used to notify patients prior to
a service being received that there may be a chance that in their
situation it may not be covered/paid (PDF Format)
www.cms.hhs.gov/MLNGeninfo/ CMS' Medicare Learning Network
(MLN) contains educational information for Medicare fee-for-service
providers. Located in the Centers for Medicare & Medicaid Services
(CMS),the Medicare Learning Network is a brand name for official
CMS national provider education products designed to promote
national consistency of Medicare provider information developed for
CMS initiatives.
http://www.cms.hhs.gov/TherapyServices/02_billing_scenarios.asp
This website is designed to clarify existing therapy policy and to provide
guidance on current Part B billing issues relevant to (PTs), (OTs) and
(SLPs) and to the services they provide.
www.cms.hhs.gov/transmittals/downloads/R1019CP.pdf
CMS Transmittal 1019, 08/03/06; This instruction provides additional
} limitations on outpatient therapy services, consistent with the
provisions of the Deficit Reduction Act of 2005. Certain services are
limited to certain numbers of units per day for PT OT ST billing.
On December 29, 2006, CMS issued three new transmittals regarding
the outpatient therapy cap exceptions process for 2007 (links are below).
Of significance, CMS has eliminated the manual exceptions process so all
exceptions will be automatic. Conversations between Gayle Lee, JD,
APTA's Director of Regulatory Affairs, and
CMS staff have identified that CMS eliminated the manual process
due to funding issues. This required
changes to the automatic exceptions process. The changes to these
transmittals are denoted in red font in the published transmittals.
www.cms.hhs.gov/transmittals/downloads/R1145CP.pdf
www.cms.hhs.gov/transmittals/downloads/R181PI.pdf
http://www.cms.hhs.gov/transmittals/downloads/R63BP.pdf
www.cms.hhs.gov/Transmittals/downloads/R1106CP.pdf
www.cms.hhs.gov/Transmittals/downloads/R171PI.pdf
CMS Transmittal 171, 11/09/06; Outpatient Therapy Cap Clarifications-
Clarifies contractor instructions related to therapy cap exception process. www.cms.hhs.gov/Transmittals/downloads/R140PI.pdf
CMS Transmittal 140, 02/15/06; Therapy Cap Exceptions Process -
Medicare Program Integrity Manual Medicare Part B Resources Therapy Cap www.cms.hhs.gov/Transmittals/downloads/R855CP.pdf
CMS Transmittal 855, 02/15/06; Therapy Cap Exceptions Process - Medicare
Claims Manual CMS Fact Sheet on Therapy Cap Exceptions Process
Medicare Part B Resources Therapy Cap
www.cms.hhs.gov/MLNMattersArticles/downloads/MM4364.pdf
Medlearn Matters article describing the Therapy Cap Exceptions Process
Correct Coding Initiative (CCI) Resources:
www.cms.hhs.gov/MLNMattersArticles/downloads/SE0545.pdf
Medlearn Matters article describing the application of CCI to all outpatient
settings
www.cms.hhs.gov/NationalCorrectCodInitEd/
CMS' Correct Coding Initiative (CCI) Edit website to provide information on
CCI edits and a portal to other related sites.
This page takes the reader to ALL related downloads on NCCI,
including the updated Jan1 2007 CCI edits,
appropriate use of the 59 modifier, and other payer instructions
regarding CCI applic
ations.
Medicare Fee Schedule Resources:
www.cms.hhs.gov/physicianfeesched/downloads/cms-1321-cn.pdf?agree=yes&next=Accept
This correction notice corrects a limited number of technical and
typographicalerrors in the final rule with comment period that appeared
in the December 1, 2006 as related to the Medicare Program;
Revisions to Payment Policies, Five-Year Review of Work Relative
Value Units, and Changes to the Practice Expense Methodology
Under the Physician Fee Schedule, and Other Changes to Payment
Under Part B.
www.cms.hhs.gov/PhysicianFeeSched/
The information that is provided on the CMS physician fee schedule (PFS)
web page relates to payment under the PFS and related
information concerning the development of the payment
amounts. This information is intended for physicians/non-physician
who provide services to Medicare beneficiaries.
This information is updated on regular basis when
there are payment/policy changes.
FOR ALL THERAPISTS
National Provider Identifier (NPI) Information:
www.cms.hhs.gov/NationalProvIdentStand/
HIPAA INFORMATION
http://www.hipaadvisory.com/regs/finalsecurity/
www.hhs.gov/news/facts/privacy.html
Toll free info hotline: 866-627-7748
Hughes, Gwen, RHIA Understanding the Privacy’s Rule Amendments.
Journal of American Health Information Management Association,
Nov-Dec. 2002, 73-10
Amatayakul, Margaret, RHIA and Johns, Meridia L., PhD, RHIA.
Compliance in the Crosshairs: Targeting Your Training.
Journal of American Health Information Management Association,
Nov-Dec. 2002, 73-10
Business Plans and Development
www.sba.gov/starting/indexbusplans.html:
http://www.sba.gov/
http://www.lectlaw.com/
http://www.awsource.com/
http://www.hg.org/
www.cnnfn.com/smbusiness
PROPER HIRING and EMPLOYEE CLASSIFICATION PROCEDURES
Department of Labor: http://www.dol.gov/
Internal Revenue Service http://www.irs.gov/
(also to get Form SS-4 for a tax identification #
Proper and improper pre-employment questions: http://www.nolo.com/
PROFESSIONAL RESOURCE CENTER
Hand Therapy
HTCC - Hand Therapy Certification Commission
Occupational Therapy
AOTA - American Occupation Therapy Association, Inc.
NYSOTA - New York State Occupational Therapy Association, Inc.
Physical Therapy
NYPTA - New York Physical Therapy Association
APTA - American Physical Therapy Association
Speech Therapy
ASHA - American Speech - Language Hearing Association
General
American Academy of Physical Medicine and Rehabilitation
American Congress of Rehabilitation Medicine
American College of Sports Medicine
Institute for Preventative Sports Medicine
National Athletic Trainer Association
National Association of Disability Evaluating Professionals
We want to thank the following corporate sponsors.
Serving PTs OTs STs and Group Practices
99 Hudson St., 12th Fl.
New York, NY 10013
Phone: 212-233-8911
Wats: 800-221-4904
URL: http://www.insurancemarketplace.com/updateClickThru.aspx?URL=www.cmfgroup.com&ID=1699
Questions about coverage?
Contact: Martin J. Liston CIC
212 233-8911 ext 346 or 1-800-397-3008
email:
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CPC Medical Services- A medical billing and claims recovery company for OTs PTs STs
450 Seventh Avenue 8th Fl.
NY NY 10123
212 213-0877
http://www.cpcmedical.com/
For information on any aspect of billing and claims recovery, please email Zachary Martinez at
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.
Legal Services
Farrel Fritz PC has an innovate Health Care Practice Group with partners that understand the needs of therapists and business entities in the health care arena.
Christopher J. Kutner, Esq.
ckutner@farrellfritz
516-227-0609
Mr. Kutner previously was counsel for HIP of Greater New York and Vytra Health Plans.
Michael E. McDermott,Esq.
mmcdermott@ farrellfritz
516-227-0636
Mr. McDermott previously was counsel for both Lenox Hill Hospital and Lutheran Medical Center
Farrell Fritz, P.C.
2488 Montauk Highway
Bridgehampton NY 11932
(631) 537-3100
East Hampton 631-324-0512
290 Broad Hollow Road
Melville NY 11747
(631) 547-8400
405 Lexington Avenue
NY NY 10174
(212) 687-1230
EAB Plaza
Uniondale NY 11556
(516) 227-0700
www.farrellfritz.com
To receive their quarterly newsletter, please contact: healthcare@farrellfritz
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