To all RMS clients and friends;
We would like to make you aware of a couple of different issues:

1. There are a few changes in ICD-10 codes beginning 10/1/24 that will impact Therapy Clinics. For more information, you can go to the following links:

   a. https://discover.webpt.com/docs/webpt-emr-icd-10-yearly-updates

   b. https://www.cms.gov/medicare/coding-billing/icd-10-codes

2. If you are currently using World Pay as your credit card vendor, you have the ability to set up an online payment option via your patient statement in WebPT Billing. For more information, you can read about it on this link. If you have any questions you can read more at https://discover.webpt.com/docs/webpt-billing-online-patient-payments (https://discover.webpt.com/docs/webpt-billing-online-patient-payments)

3. If you do want to set up payments for 2 above, let us know and we will submit a Support ticket with WebPT Billing

4. We are interviewing two different vendors for telehealth and remote monitoring services. If this is something your clinic is interested in, please let me know.

5. Finally, many of our clients are confused about the difference between Regular Medicare and Medicare Replacement plans/MCO’s. This is due to patients bringing/presenting both cards at their start of care. It is important to distinguish which coverage the patient has. While Medicare is more forgiving, we are seeing preauthorization becoming more of an issue and setting up the wrong insurance can lead to denials that COULD BE non-appealable. It is important that your staff verify benefits before the start of care. Take note that Medicare will show as active, but the MCO information will be listed separately. It is important that you look at the MCO information when verifying the benefits with Medicare. One way of minimizing this is to utilize the electronic benefit verification built into the WebPT EMR. Monthly plans can start as low as $15 for 20 monthly eligibility verifications. If you have questions about this, let me know and I can connect you with someone at WebPT to discuss pricing.

Clients and Friends of Rehab Management

We just want to provide you and your front office staffs with some annual reminders:

1. The beginning of the New Year kicks off many employers switching their health insurance coverages from one insurance company to another. We advise that your front office staff re-verify all insurance coverages to start the New Year. If a patient’s coverage has changed and the new coverage isn’t identified, we bill the old insurance and your claims will deny, which can take anywhere from days to a couple of weeks. Once we get this sorted out, your staff then has to chase down the patient to obtain the new insurance coverage and we start the billing cycle over again. Note: Many insurance companies require pre-authorization, so switches like this can lead to multiple types of delays, denials and $0 payments for services. Better to re-verify upfront than spending hours of administrative time appealing and hoping to get paid after the treatment has been provided.
2. New Year means new deductibles. For 2025 Medicare has set the deductible at $257. You will want to collect these deductibles at the time of service. January and February are historically the toughest collections months of the year. Collecting up front helps mitigate the cash flow decline!
3. Cash flow slows down beginning in late January as the insurance companies process claims and apply the annual deductible. Deductibles generally hit hard in late January and continue through mid to late February. About the only way to avoid cash flow slowing down is to collect deductibles, coinsurance and copay amounts up front. Also note that your cash flow decline has nothing to do with our billing or your front office staff’s performance. It happens every year and like bird migration patterns, cash flow returns in March with a typical strong flourish.

Additionally, Medicare changes for 2025 (highlights only) include the following:

1. Therapy threshold is $2,410 for 2025 (KX’s have to go with claims after that to support medical necessity of continued care). OT’s have that threshold and PTs/SLPs still share that $2,410 threshold
2. Targeted Medicare review is $3,000 and will remain at that level through the end of 2027. This has not changed from the prior year.
3. One final clarifying note-Medigap plans C & F were designed to cover the Medicare patient’s deductible. These plans were stopped effective 1/1/2020. However, patient’s that had purchased these plans PRIOR TO 1/1/2020 have been grandfathered with these plans, meaning they can continue to renew them for as long as they want to. So please note that your patient’s insurance (unless they have these Medigap plans) will not cover the Medicare deductible-thus your front office staff will want to do that during the patient visit.

From all of us here at Rehab Management Services, we wish you a very Merry Christmas and a Happy New Year!