CMS’ Advance Beneficiary Notice (ABN) Frequently Asked Questions

When and how to use ABN

By Mary R. Daulong, PT

Understanding how to use the Medicare Advance Beneficiary Notice (ABN) properly is critically important because it has financial, fraud, and abuse consequences. Using it correctly could permit providers to collect monies legally that may otherwise have been left on the table. Misusing it could result in fraud and abuse investigations, refunds, fines, penalties, and administrative sanctions. Providers must know and comply with billing and coding regulations when they bill Medicare or any other payer.

Public Health Emergency Is Now Over

person standing upright

What does that mean for assistant supervision, maintenance therapy, and telehealth under medicare part b therapy services for private practices?

By Rick Gawenda, PT

The public health emergency (PHE) was officially over at the end of the day on May 11, 2023. What physical therapists in private practice want to know is how does the end of the PHE impact physical therapist assistant (PTA) supervision requirements, the ability of a PTA to provide maintenance therapy under the direction and supervision of the physical therapist, and the ability to provide and be reimbursed for outpatient therapy services delivered via telehealth.

Q&A: Balance Billing as an Out-of-Network Provider

calculating numbers

Changes since the No Surprises Act

By Lanchi N. Bombalier, JD, MPH, PT, and Mary R. Daulong, PT

This article updates the payment resources published by APTA Private Practice in January 2021 to address new regulations and requirements related to balance billing under the federal No Surprises Act, which became effective on January 1, 2022.1 It provides general information and education about commercial insurance coverage for outpatient therapy services rendered by out-of-network (OON) providers. However, and is not intended to address the requirements or guidance for any specific commercial insurance plan or applicable state laws. It does not constitute legal advice or legal representation. For legal advice, members should consult an attorney in their state.

Third-Party Billers: Compliance and Risk

Bearded man holding his head while reviewing papers

Ask the right questions

Nancy J. Beckley, MS, MBA

The first, and probably the most often asked question when selecting a third-party biller is “how much does it cost?” In the absence of a list of criteria to ask when selecting a third-party biller, the question of “cost” is an easy question and often a decision point in final selection. To take a look at this from a compliance perspective, let’s flip the switch and ask the “cost” question in another way. “How much could a third-party biller cost my practice if the right questions were not asked?”

2023 Medicare Regulatory and Payment Updates

Books of rules and regulations
By Rick Gawenda

On November 1, 2022, the Centers for Medicare and Medicaid Services (CMS) issued the calendar year (CY) 2023 final rule for services reimbursed under the Medicare Physician Fee Schedule (MPFS). In this article, I will provide you with the changes that will have an impact on your outpatient physical therapy services and practice.

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