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Discharge Planning Final Rule Sub-Regulatory Guidance

Published on 

Tuesday, January 21, 2020

 | RAC Information 
 | FAQ 

Q:

I recently read the MMP article New Modifiers for Therapy Assistant Services. Are you aware of any other payors adopting a similar policy?


A:

Humana published Policy Number CP2018009 on December 10, 2019. This policy applies to both Medicare Advantage and Commercial Coverage. Similar to CMS guidance, effective January 1, 2020 or later Humana requires providers to submit a “charge for an outpatient occupational or physical therapy service…with modifier CO or modifier CQ, as applicable standards in the Federal Register and relevant CMS guidance direct.”

You can find the entire policy on Humana’s website at https://www.humana.com/provider/medical-resources/claims-payments/claims-payment-policies.

CMS’ guidance for Medicare Fee-for-Service beneficiaries is available in the November 1, 2019 Transmittal 4440 at https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2019downloads/R4440cp.pdf.

Article Author: Beth Cobb, RN, BSN, ACM, CCDS
Beth Cobb, RN, BSN, ACM, CCDS, is the Manager of Clinical Analytics at Medical Management Plus, Inc. Beth has over twenty-five years of experience in healthcare including eleven years in Case Management at a large multi-facility health system. In her current position, Beth is a principle writer for MMP’s Wednesday@One weekly e-newsletter, an active member of our HIPAA Compliance Committee, MMP’s Education Department Program Director and co-developer of MMP’s proprietary Compliance Protection Assessment Tool.

This material was compiled to share information.  MMP, Inc. is not offering legal advice. Every reasonable effort has been taken to ensure the information is accurate and useful.