This 2-part session will teach participants differences between traditional Medicare and Medicare Advantage plans rules and regulations as they pertain to outpatient physical, occupational and speech therapy services. The session will provide the latest available information on TRICARE and the use of physical therapist assistants and occupational therapy assistants. The session will review the 2019 therapy threshold, how to calculate the dollar amount that is applied to the annual therapy threshold, and the targeted medical review for claims exceeding $3,000 in a calendar year. In addition, the session will teach participants the Targeted Probe and Educate (TPE) program that CMS has implemented to reduce claim denials. The session will also teach participants about the Qualified Medicare Beneficiary Program and how suppliers and providers can’t bill Medicare patients in this program for Medicare deductibles, copays or coinsurance. Finally, this session will provide the 2020 outpatient therapy updates concerning new, revised, and deleted CPT codes, Medicare Beneficiary Identifier and the new PTA and OTA modifiers that must be appended to CPT codes that were provided in whole or in part by a PTA or OTA to a traditional Medicare beneficiary.*
CEUs are offered for this session.