Worried about compliance? Since ReDoc® powered by xfit® is perfectly fitted for rehab therapy, we don’t just generically monitor regulatory changes. Instead, we watch with a keen eye towards anything that affects your medical record and coding needs. Learn about the regulatory changes that Net Health stays ahead of to help keep clients in the know and support compliance requirements.
Functional Limitation Reporting
CMS has ended the requirements for the reporting and documentation of functional limitation G-codes and severity modifiers for outpatient therapy claims starting on January 1, 2019. While the FLR G-codes will not be reimbursable, they will be retained until 2020 to allow time for therapy providers and private insurers who use these codes to update their billing systems and policies. In ReDoc, you can choose to disable or continue to use FLR in 2019.
ICD-10-CM
Net Health keeps up with the latest ICD standards, including updating the code changes each October. Accurate ICD-10-CM code selection is required to meet medical necessity and carrier policy requirements, which are necessary for reimbursement.
Monitoring of Final Rules/Laws (Federal Register)
Keeping track of additional programs like Outpatient Prospective Payment System (OPPS) and Medicare Physician Fee Schedule (MPFS) Rules can feel overwhelming when you are also trying to treat patients and run an efficient clinic. We’ve got you in mind. Our Product Compliance Team works tirelessly to monitor these programs and provide updates to ReDoc powered by xfit to help support your clinic’s compliance with existing and ever-changing regulatory requirements that affect your EMR.
KX Modifier Threshold Amount
After two decades, a permanent end to the Medicare Therapy Cap was signed into law on February 9, 2018. Although this is great news, Medicare maintains that therapists are still required to apply the KX modifier for specified annual Medicare amounts each year. ReDoc provides tools to monitor these amounts in order to address the KX modifier when necessary.
NCCI Edits
ReDoc supports the NCCI Edits that are applicable to modifier 59 with prompt notifications to help you avoid potential denials.
The Joint Commission
The Joint Commission standards “focus on important patient, individual, or resident care and organization functions that are essential to providing safe, high quality care.”1 We understand that complying with The Joint Commission Standards is important to our clients. That’s why ReDoc provides the tools and necessary documentation elements to comply with the requirements set forth by The Joint Commission.
MACRA and MIPS
The Merit-based Incentive Payment System (MIPS) is one of the two tracks offered under the Quality Payment Program for Medicare. As of 2019, physical therapists, occupational therapists, and speech language pathologist are considered eligible clinicians and those who bill to Medicare Part B may be required or may be able to choose to participate. Eligible Clinicians are required to participate in MIPS if they exceed all of the following three criteria over a 12-month period:
- Bill more than $90,000 in Medicare Part B Claim Charges
- Provide care to more than 200 Part B Beneficiaries
- Provide more than 200 Covered Professional Services
If you meet 1-2 of the criteria, you may choose to opt-in. If you do not meet any of the criteria, you cannot participate for an incentive payment.
In 2019, two of the four MIPS categories apply to therapists: Quality (formerly known as PQRS) and Improvement Activities.
Check your QPP participation status by performance year with your NPI number by using the CMS QPP Participation Status tool here.
To learn more about:
- The MIPS track for therapists, click here to visit the QPP website
- How ReDoc supports your MIPS participation, contact info@nethealth.com or 800-411-6281 Option 3.
Optional PTA and OTA Modifiers
CMS finalized two new modifiers, CQ and CO, to show when more than 10% of a service was furnished by a PTA and OTA. These modifiers are optional for 2019 but will be required in 2020. In ReDoc, you can choose to voluntarily use these modifiers in 2019.
1 Facts about Joint Commission standards. (2016, March 25). Retrieved January 24, 2017, from www.jointcommission.org/facts_about_joint_commission_accreditation_standards/
