Medicare Coverage, Payment & Denials
It is critical to understand that coverage and payment for therapy services, while related, are separate terms and are regulated by separate authority. This Course reviews coverage and also claim denials.
1.0 CEU PT/OT/ST
Understand Medicare Coverage Guidelines and the difference between National and Local Coverage Determinations (NCDs and LCDs).
Recognize the difference between payment and coverage and the inter-relationship between the two.
Learn about Business Tax Receipts, what they are and how to obtain one for your business.
Define the terms: Therapy Cap, -KX Modifier, Therapy Threshold. Additional Development Request (ADR) and Targeted Probe and Educate (TPE).
Understand the importance of documentation in meeting coverage criteria and, therefore, receiving payment.
Know the most common errors identified in documentation and how to avoid them.
Have a process of best practice to respond to ADRs or TPEs.
1.0 CEUs
Welcome
Course Descriptor
Really Useful Links & Downloads
Payment Terms
Understanding Medicare Coverage
CERT Errors
Survey
Take the Quiz
Please reach out if you would like to talk to a human!
Yes! This is part of the 3 Hour Modular Course, "Maintenance Therapy. A BluePrint for Success" which is approved/registered in 8 States and accepted in 17 States. A Modular Course means that you can take a portion of the course and still earn credit.
We hope so! We add states based on member request and are approved, registered or accepted in the following States: AL, AZ, DE, DC, FL, GA, HI, ID, KY, MI, MO, MS, NC, ND, OH (OT only), PA, RI, SC, TN, UT, VT, VI, WY.
It DOES NOT mean that in the remaining states, our courses will not count toward your CEUs - it just means that the process may need to be manual (self-reported). Ask your ITA team if you have questions and we will check the process for you.
Of course we do! :-) Courses are uploaded within 24 hours. If you don't see your course in this timeframe, give us a call.
You will have instant access to your Certificate through your classroom to download, print or just show off what you have accomplished!