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Hospital Outpatient PT/OT/ST Services Can Now Be Provided via Telehealth

On April 30, 2020, CMS issued a second round of sweeping changes to support the healthcare system during the COVID-19 Pandemic. One of these changes is the waiving of limitations on the types of clinical practitioners that can furnish Medicare telehealth services. Prior to this change, only doctors, nurse practitioners, physician assistants, and certain others could deliver telehealth services. With this change, other practitioners are able to provide telehealth services, including physical therapists, occupational therapists, and speech language pathologists.

Until this change, therapists could only provide e-visits, a separate category of remote delivery of services. Even so, however, these services were only payable if billed on a CMS 1500 claim form. Hospital outpatient therapy services billed on the UB-04 claim form was excluded from being reimbursed for e-visits.

This is a great opportunity for hospital-based outpatient therapy, however, it can also set the stage for great risk. As you move to this new platform, make sure your team understands the operational implications (e.g. patient consent, acknowledgment of privacy notice) and regulatory compliance for billing, coding, and documentation. Blue & Co. can provide guidance in this area. For more information, contact our telehealth team.

Pharmacy Benefit Managers: What is Your Plan Paying For?

Pharmacy Benefit Managers: What is Your Plan Paying For?

The world of pharmacy benefits continues to get more complicated, and that is unfortunately not an accident. Pharmacy benefit managers, also known as PBMs, such as Optum, CVS Health, and Express Scripts, cover more than 80% of the American public’s pharmacy needs. Due to their size and control over the pharmacy industry, they can negotiate […]

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pharmacy benefits

On-Demand Webinar: Transparency and Control, Demystifying Pharmacy Benefits

The world of pharmacy benefits is not transparent by design — pharmacy benefit managers do not want you to look into where your costs are truly going. Join Blue & Co., LLC on Tuesday, April 13 from noon to 1 p.m. for a webinar where our team of Pharmacy Consultants will explain how pharmacy benefit […]

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Revenue Improvement

Revenue Improvement Case Study: Outpatient Physical and Occupational Therapy

Blue & Co. reviewed publicly available information on a 120 bed, non-profit, acute-care hospital. The data suggested there was revenue improvement opportunity in their outpatient physical and occupational therapy departments. The department had approximately 27,000 patient visits the previous year. During an assessment, we co-validated a significant set of revenue improvement opportunities: charge capture improvement, […]

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