Current News

Evaluation and Management Payment Guidelines

Published on October 31, 2019

Effective November 1, 2019, any claim for E&M codes (except 99201 – 99205) billed with or without a modifier 25 billed the same day as a procedure, received without the appropriate medical record documentation will result in a denial of this line item in the claim. If your claim is denied due to E&M coding rules, in order to be re-considered, your claim must be resubmitted with the required medical record documentation to substantiate the service.

2019 Q4 Newsletter

Published on October 25, 2019

Our latest newsletter is out. In this edition we have: How Can I Help Prevent Fraud and Abuse?, Authorizations requests, UM Documentation Checklist, Claims & Billing Reminders, Keep your demographic information updated!, Clinical Practice Guidelines, Important things to remember when submitting credentialing documents, EFT & Regulatory Trainings, Changes?, How to use modifier 25 and Annual Quality Improvement Documents

Evaluation & Management New & Established Patient Table

Published on October 14, 2019

When billing office or other outpatient services for new or existing patients, KEY COMPONENTS must be fully documented in order to bill. Please read the bulletin to familiarize yourself with the key components.

Our Provider Web Portal and Its Security Features

Published on May 21, 2019

HS1 will assign the primary, or Account Owner, account. The Account Owner creates and assigns any other usernames for additional staff members. Employees should never share their credentials – each user should have their own username! Account credentials should not be shared amongst staff.

Required Documentation for All Authorization Requests

Published on April 18, 2019

As of June 1st, 2019, all treating providers must submit supporting documentation along with every authorization request to help you understand what is needed in every case. The guide above will help you understand what is needed in every case.

2018 Q3 Newsletter

Published on August 20, 2018

Nuestro último boletín informativo de TNPR está disponible. En esta edición encontrarás: * ¿Cómo Puedo Verificar Mi Participación con Medicare? * Elegibilidad de Afiliados * Servicios a Pacientes Durante el Periodo de Emergencia * Mejorando Nuestros Procesos Gracias a Adelantos Tecnológicos * Adiestramientos Regulatorios Anuales

2018 Q1 Newsletter

Published on March 28, 2018

Nuestro último boletín informativo de TNPR está disponible. En esta edición encontrarás: * Ley 14-2017 - Ley de Incentivos Para la Retención y Retorno de Profesionales Médicos * Participación con Medicare * Mantén tu Información Actualizada * Cambio de Números de Teléfono de los Representantes de Servicio de TNPR * Verificación de Listas de Exclusiones * Resultados de la encuesta del 2017

Updates to Our Provider Web Portal

Published on May 30, 2017

We are pleased to announce the upcoming release of a new version of the Provider Web Portal (PWP). Available June 1, 2017, the new version will have a new look and new functionality that will allow you to be more effective, self-sufficient and paperless.

2016 Q4 Newsletter

Published on Mar 22, 2017

Dear Provider, TNPR's latest edition of our Provider Newsletter is out. In this issue: Códigos de Evaluación*Cambios en Códigos de Evaluación*Relevo de Retención de Hacienda*Validating Your Patients Information With Their Health Plan*EDI 835 Health Care Payment/Remittance Advice*Claim Submission Reminder*New Medicare and Medicaid PT and OT evaluation and re-evaluation procedure codes for 2017*Patient access to Medical Records*Tips for a Productive Peer to Peer Review*Contact Us Information

2017 Actualización Anual de la Lista de Códigos de OT y PT

Published on Dec 21, 2016

El Panel Editorial de Terminología de Procedimientos Actuales (CPT, por sus siglas en inglés), creó ocho (8) nuevos códigos (97161-97168) que reemplazan el conjunto de cuatro (4) códigos (97001-97004) previamente usados para los procedimientos de evaluación de Terapia Física (PT) y Terapia Ocupacional (OT).

Evaluation and Management Payment Guidelines

Published on Dec 12, 2016

Effective February 1, 2017, any claim for these codes received without the required medical record documentation will result in a denial of this line item in the claim. To be considered for payment, the claim must be resubmitted with the required medical record documentation.

Códigos G Para Informes Funcionales

Published on Dec 05, 2016

Desde el 1 de enero de 2013, los Centros de Servicios de Medicare y Medicaid (CMS, por su siglas en inglés) han aplicado un requisito de recolección de datos basado en reclamaciones para servicios de terapia ambulatoria para patología de habla, disciplinas de terapia ocupacional y física) en sus solicitudes de formulario de reclamación.

Medicare Mandatory Modifiers

Published on Nov 04, 2016

In an effort to achieve compliance with CMS Billing Requirements, Therapy Network of Puerto Rico (TNPR) is adopting the GN, GO, and GP therapy modifiers in accordance with published CMS billing requirements. Providers NEED TO USE the below modifiers on ALL THERAPY CLAIMS submitted for consideration for Speech Therapy, Occupational Therapy or Physical Therapy.

Q2 Newsletter

Published on Oct 17, 2016

Dear Provider, TNPR's latest edition of our Provider Newsletter is out. In this issue *Documentation Requirements For Therapy *Fraud, Waste, and Abuse (FWA) *Apollo Guidelines *Proper Use Of The 7th Character In ICD-10 *Appointment Availability *6 Points To Remember When Recredentialing

VPay Implementation

Published on Jun 08, 2016

Therapy Network of Puerto Rico (“TNPR”) has partnered with StoneEagle’s patented VPay® process to provide a faster, more efficient way to reimburse your practice for services rendered. VPay allows your practice to receive payments electronically, utilizing either a MasterCard® transaction or an ACH/EFT. Please note that the option to receive a check payment will still be available.

Q1 Newsletter

Published on Apr 11, 2016

Dear Provider, TNPR's latest edition of our Provider Newsletter is out. In this issue.... * Check Eligibility and Validate Your Patients Information With Their Health Plan * Rehabilitative

Facturacion De Procedimientos Guiados Por Sonografia

Published on Mar 16, 2016

Efectivo el 1ro de Abril de 2016 los códigos relacionados a procedimientos guiados por sonografía serán incluidos en la lista de servicios que no requieren preautorización para poder ser facturados por todos aquellos fisiatras que hayan pasado por el proceso de TNPR de validación de sus certificaciones.

Q4 Newsletter 2015

Published on Mar 14, 2016

We are pleased to present our Provider Newsletter 2015 Summer Edition. In this Summer Edition we present the following topics, that we know are going to be of your interest: Request for Medical Records * Correct Claims Code for an Initial Visit * ICD-10 Transition update

Medicare Part D Prescriber Enrollment

Published on Mar 02, 2016

Beginning June 1, 2016, prescribers who write prescriptions for Part D drugs must be enrolled in an approved status or have a valid opt-out affidavit on file with Medicare in order for their prescriptions to be covered under Medicare Part D. Before opting out of Medicare, you should consider the following impacts:

Provider Enrollment Revalidation Call

Published on Feb 17, 2016

What's ahead for your next Medicare enrollment revalidation? Learn what you need to do and about the new resources available to help you stay on top of the process every step of the way. Join CMS experts as they discuss the timing, improvements, and updates for the second round of revalidations required by the Affordable Care Act and 42 CFR §424.515. A question and answer session will follow the presentation.

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