The Medicare Payment Advisory Commission (MedPAC) relased their June report to Congress last week.  Of note to the rehab and therapy community is Chapter Eight:  “Addressing the Growth of Ancillary Services in Physician Offices.”

The chapter on ancillary services addresses outpatient therapy including physical, occupational and speech therapies.  Of note is the discussion regarding the growth of ancillary services which includes eliminating outpatient therapy from the in-office ancillary exception to the Stark regulations, noting that “incident to” services declined from 30 percent share to 16% share of spending for therapy services.  Also discussed is limiting the exception to practices that are clinically integrated.

The report consists of eight chapters:  2 chapters on the themes of Medicare payment accuracy and moving away from the   inherent volume incentives present in Medicare fee-for-service.  Three chapters highlight systemic changes to better align provider incentive with a “reformed delivery system.”  The role of beneficiaries in the delivery system reform.  The report also includes a chapter that discussed the role of CMS as a “value” purchaser vs. a “claims payer”.

For private practitioners working or employed in physician offices (billing under their own Medicare provider number assigned to the group), as well as those billing “incident to” under the physician number, put Chapter 8 on your summer reading list.

The HHS Office of the National Coordinator for Health Technology released the final rule today that includes provisions for temporary certification of programs for EHR.  (This will eventually be replaced by a permanent certification program).  The entire press release can be found at the HHS website. 

“By purchasing certified EHR technology, hospitals and eligible professionals and hospitals will be able to make EHR purchasing decisions knowing that the technology will allow them to become meaningful users of electronic health records, qualify for the payment incentives, and begin to use EHRs in a way that will improve quality and efficiency in our health care system,” said David Blumenthal, M.D., M.P.P., national coordinator for health information technology.  “We hope that all HIT stakeholders view this rule as the federal government’s commitment to reduce uncertainty in the health IT marketplace and advance the successful implementation of EHR incentive programs.”

According to the press release use of certified EHR technology  is a core requirement for providers who seek to qualify to receive incentive payments under the Medicare and Medicaid Electronic Health Record Incentive Programs  which was authorized by provisions  in the  HITECH Act as part of the American Recovery and Reinvestment Act (ARRA) of 2009.   CMS will issue final regulations to implement the EHR incentive programs also according to the press release.

For therapy and other small providers seeking to move to an electronic health record platform it is time to get in touch with the vendors that you have been considering, your incentive payments will depend on their certification through this program.

CMS has updated the “Rehabilitation Therapy Information” Fact Sheet and it is now available for downloading at the CMS website.  The 4 page flyer inlcudes highlights over therapy changes over the past year including the therapy cap, DME Instructions, SLP in Private Practice, and Therapy Personnel Requirements.  There are also links to rehab related Medicare Learning Network (MLN) articles, as well as information on the CCI edits.

Other linked resources include the CMS Therapy Services webpage, rehab sections in the Medicare Benefit Policy Manula as well as the Medicare Claims Processing Manual, provider enrollement information and therapy studies and reports.  In other there are other general provider resouces links for fraud and abuse, beneficiary notices, and the physician fee schedule look-up.

CMS has recently announced a new round of RAC informational sessions for providers.  The video features the slide show used in the original fall RAC informational sessions along with commentary by Commander Marie Casey.  This video production is one of many that have been posted by CMS/HHS on YouTube.  This video is being released as CMS announces a series of RAC 101 informational meetings to be held in the next several weeks.

www.youtube.com/watch?v=IHFXsfP99Bc

CMS has announced the therapy cap for 2010 is $1860, representing a $20 increase over the 2009 therapy cap.  Transmittal R1851 to the Medicare Claims Processing Manual, dated 11/13/2009 and the accompanying MLN Article MM6660 provide information on the implementation.  The Balanced Budget Act of 1997 (BBA) established a $1500 therapy cap for physical therapy (including speech-language pathology) and a separate therapy cap of $1500 for occupational therapy.  The Deficit Reduction Act of 2005  implemented the therapy caps exceptions process based on medical necessity of therapy beyond the caps.

Although the Medicare Improvements for Patients and Providers Act of 2008 (MIIPPA), Section 141, extended exceptions to therapy caps through December 31, 2009, there is indications in the various healthcare reform proposals that the therapy caps exceptions process will be exteneded though 2011, although there is no certainly at this point. 

While Medicare beneficiaries will enjoy the benefit of an additional $20 annually of therapy services under under each therapy cap, therapy providers should brace for the projected 21.2% reduction in the conversion factor in the Medicare Physician Fee Schedule for 2010.

The therapy caps are applicable to outpatient settings including private practice physical, occupational and speech therapy practice, rehab agencies (ORFs) and comprehensive outpatient rehab facilities (CORFs).  Hospital outpatient therapy departments with provider-based status are exempt from the therapy caps and provide a safety net for beneficiaries to receive additional therapy that may not be covered by a diagnosis code, co-morbidity, or complexity identified to meet the medical necessity requirements.

Trailblazer , the MAC J4 contractor has released a DRAFT Physical Medicine & Rehabilitation Outpatient LCD (local coverage determination).   The draft LCD is posted as of October 30, 2009 for a 45 day comment period that ends December 14, 2009.  According to Trailblazer:

This LCD establishes frequency limitations of 5 (15-minute) PT or OT services per day and 60 (15-minute) PT or OT services per month. Providers of PT/OT services must be aware however, that any service reported to Medicare, even when reported at a frequency within the following stated covered guidelines, may be denied if done so in association with medical review of the patient’s record. Likewise, providers of PT/OT services must understand that though Medicare will allow the following units of service, each service must be medically reasonable and necessary for the specific patient and his or her condition. Additionally, Medicare expects that the patient’s medical record will clearly demonstrate that medical necessity. Further, Medicare does not expect that maximum allowable services will be routinely necessary, necessary for multiple week periods, or necessary for the entirety of the patient’s course of treatment.

This LCD also include a procedure to diagnosis edit list (78 pages long).

National Government Services (NGS) has posted the schedule for their first ever virtual Medicare University Convention to be held November 16-20, 2009.  Last year this convention was held as a live event in Indianapolis, and citing the significant savings in travel and expense, NGS has announced a reduction in the registration fee from $175 to $150.  Attendees pay one registration fee and are able to attend all the virtual courses being held in three virtual lecture halls.

• Medicare Part A Courses
• Medicare Part B Courses
• Medicare Part A and B Courses
• Durable Medical Equipment Courses
• Home Health and Hospice Courses
• Federally Qualified Health Centers Courses
• General Courses for All Contracts

For rehab professionals there are three rehab topically oriented courses, including outpatient and inpatient rehabilitation facilities.  There are other topics of interest to rehab providers including CERT, Medicare PECOS enrollemnt, MSP, EHR, compliance and billing incident-to.  NGS has posted the course descriptions for timeline.

There seems to be a bit of panic spreading in the therapy community, that is more of a misunderstanding regarding the standing of private practice therapists providing DME supplies for their patients.  There seems to be a particular concern for those providing hand therapy services including splints, and wondering if they have to meet the October 1, 2009 deadline for accreditation.

Palmetto GBA, lists the exemptions chart pertaining to the accreditation and surety bond requirements.  In a nutshell physical therapists and occupational therapists are exempt from the accreditation requirements.  Additonally physical therapists and occupational therapists are exempt from the surety bond requirements if the following three conditions are met:

1. The business is solely owned and operated by the PT/OT
2. The items are furnished only to the PT/OT’s own patients as part of his/hers professional service and,
3. The business if only billing for orthotics, prosthetics and supplies

If you are a practicing therapist meeting the description above, but have received notification that you must provide evidence of accreditation or a surety bond, it is impertivie to contact the Clearinghouse and ensure that your application data on file contains documentation of your exemption if you so qualify.  Appropriate contact information is posted on the Palmetto GBA website.

DMEPOS suppliers are encouraged to view the accreditation and surety bond frequently asked questions for more detailed information.