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Updated Editing of Always Therapy Services - MCS

This MLN Matters Article is intended for therapists, physicians, and certain other practitioners billing Medicare Administrative Contractors (MACs) for therapy services provided to Medicare beneficiaries. Services furnished under the Outpatient Therapy (OPT) services benefit – including SpeechLanguage Pathology (SLP), Occupational Therapy (OT), and Physical Therapy (PT) – are subject to the financial limitations, known as therapy caps, originally required under Section 4541 of the Balanced Budget Act (1997). Read the entire article

The problem of martyrdom in medicine

I recently read the award-winning physician essay in Medical Economics entitled “Lunch is for Losers,” about the sacrifice that physicians make for patient care. As I read this doctor’s reflections of keeping crackers and candy bars in his lab coat pockets because he didn’t have time to eat during his med school days, it reminded me of the GYN attending I had in my residency who loved to cheerfully tell bleary-eyed interns: “You can sleep when you’re dead.” Read More...

Medi-Cal postponing deactivation of inactive providers

Earlier this month, the Department of Health Care Services (DHCS) notified approximately 30,000 Medi-Cal providers that they were being "deactivated" because they had not submitted a claim or rendered services reported on a Medi-Cal claim in the last 12 months. The notices indicated that the deactivation date would be July 22, 2017. DHCS has, however, decided to not to proceed with the planned deactivation. DHCS will instead be reconsidering what is defined as "inactivity" after the department was made aware that such deactivation would be problematic for some providers—particularly those ...

Reminder: New out-of-network billing and payment law takes effect July 1

On July 1, 2017, a new law (AB 72) will take effect that will change the billing practices of non-participating physicians providing covered, non-emergent care at in-network facilities including hospitals, ambulatory surgery centers and laboratories. The law, signed in 2016, was designed to reduce unexpected medical bills when patients go to an in-network facility but receive care from an out-of-network doctor.  Read More...