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 issued CR6899  indicating that effective 10-1-2010 outpatient rehab providers will no longer have to report value codes for the number of visits (Code 50 for PT, Code 51 for OT, Code 52 for SLP and Code 53 for Cardiac). 

This change affects Part A outpatient therapy providers (billing on CMS 1450/UB04) including CORFs, Rehab Agencies, Hospitals, SNFs, Home Health Agencies.  A corresponding MLNArticle has also been published.

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.

Florida therapy providers are beginning to report the receipt of official “demand letters” from Connolly Healthcare, the Region C Recovery Audit Contractor.   A Florida therapy provider, who asked not to be identified, has reported receiving several demand letters related to the billing of speech therapy untimed codes in units greater than one.  This provider has multiple Florida facilities and the improper billing was found, upon internal investigation to be limited to one facility and individual and likely due to a communication error. 

Connolly (Region C) was the first RAC to post CMS approved issues for automated review.  Among those issues posted was Untimed Codes, as noted in the RACMonitor article predicting likely outpatient rehab targets: http://racmonitor.com/news/43-special-bulletin/198-likely-outpatient-rehab-rac-targets-hiding-in-plain-sight.html .

The same rehab provider has received additional RAC demand letters regarding speech therapy untimed evaluation codes being billed simultaneously with speech therapy untimed treatment codes.  The findings of an internal and external investigation has led the provider to initiate appeals on claims where two  different untimed codes were billed on the same day (on the same claim).

Untimed Codes being billed in increments greater than one were noted in the RAC Demonstration in California, New York and Florida.  The RAC issue with Speech untimed codes has been on the radar screen in rehab cirles for some time due to the $3.2 million in improper speech therapy payments discovered in the RAC demo.  

Health Data Insights (Region D) and CGI (Region B) both posted Untimed Codes as a CMS approved issue for automated review.  It is likely that DCS Healthcare (Region A) has also requested CMS to approve this issue .

Connolly describes the issue as “CPT Codes (excluding modifiers KX, and 59) where the procedure is not defined by a specific timeframe (untimed codes), the provider should enter a one (1) in the units billed column per date of service.”  Additional information for providers provided as a reference by Connolly:  CMS Pub 100-04, Transmittal 1019, dated 8.3.06, pages 7-11, and CMS Pub 100-04, Ch. 5, § 20.2.  The Connolly reference can be reviewed at: http://www.connollyhealthcare.com/RAC/pages/approved_issues.aspx

For a refresher on avoiding problems with the issue of Untimed Codes there are suggestions in the following article:http://www.racmonitor.com/news/43-special-bulletin/215-catch-me-if-you-can-staying-ahead-of-the-rac-reviews-of-untimed-codes.html  (originally published in RACMonitor.com)

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.