Category: Therapist News

CMS Coding Reversal Will Apply to Claims Made Beginning January 1, 2020

Details are still emerging around exactly how CMS intends to walk back a decision to change coding methodologies that prevented PTs from billing an evaluation performed on the same day as therapeutic activities and/or group therapy activities. But we know a little more now: namely, that the decision is retroactive to January 1 of this year, the date when the short-lived system was set in place.

APTA pressed CMS for the logistics of how its do-over would be worked out as soon as its decision was announced on January 24. On January 28, CMS informed the association that while the agency is still working on its messaging to the Medicare administrative contractors, or MACs, the reversal will be extended to claims made from January 1, 2020, on.

Full article at APTA

Flex CEUs: Older Course Removal

Due to the age of the material, Flex CEUs will be removing the following courses from our library on 02/27/2020. After this date you will no longer be able to take these courses for CE credit.

Cervical Spine Injury Medical Treatment Guidelines

Hydrotherapy Outcome Measures for People with Arthritis

If you have any questions you can start a chat or call us at 1-800-413-9636 during our business hours.

Doctors average 16 minutes on the computer for every patient

For each patient they see, doctors spend about 16 minutes using electronic health records, a U.S. study finds.

Researchers examined approximately 100 million patient encounters with about 155,000 physicians from 417 health systems. They collected data on every keystroke, mouse click and second of time spent on various tasks in electronic health records (EHR) throughout 2018.

Across all specialties, physicians spent the most time in EHR doing chart review, which accounted for about 33% of total time using the records and an average of about 5 minutes and 22 seconds per patient. They spent about 24% of EHR time on documentation, averaging 3 minutes and 51 seconds per patient, and 17% of EHR time ordering things like lab tests, for an average of 2 minutes and 42 seconds.

Full article at Reuters

Humana Adopts PTA Coding System, Anticipates Payment Differential Beginning in 2022

Commercial health insurance giant Humana has announced that it’s falling in line with rules from the Centers for Medicare and Medicaid Services designed to establish an 85% payment differential for therapy services delivered “in whole or in part” by a PTA or occupational therapy assistant. Consistent with CMS, Humana is requiring use of code modifiers in 2020, with no changes to payment until 2022.

The new system, which establishes a code modifier (“CQ” for PTAs and “CO” for OTAs) began on January 1 for Medicare Part B payments. The new approach was triggered by federal law that mandated the creation of a way to denote the volume of physical therapy and occupational therapy services delivered by PTAs or OTAs, and then create a payment differential for those services. In its announcement, Humana states that its policy will mirror the CMS rule, “as applicable in the Federal Register and relevant CMS guidance.” Like CMS, Humana also is requiring the modifier on all applicable claims submitted for services delivered beginning January 1, 2020.

Full article at APTA

Patients with newly diagnosed musculoskeletal pain are prescribed opioids more often than recommended

During their first physician visit, patients experiencing newly diagnosed chronic musculoskeletal pain are prescribed opioids more often than physical therapy, counseling, and other nonpharmacologic approaches, according to a new study published in the Journal of Pain. The use of opioids over other approaches stands in contrast with clinical recommendations for the use of nonopioid pain approaches and nonpharmacologic approaches. The study included authors from the National Center for Complementary and Integrative Health (NCCIH), part of the National Institutes of Health; the University of Montreal; and McMaster University in Hamilton, Ontario, Canada.

“Particularly when the patient is experiencing pain that may become chronic, that first clinical encounter can set the course for patient care moving forward,” said Helene Langevin, M.D., director of NCCIH. “This study was designed to assess the ways in which real-world practice compares and contrasts with practice guidelines for these initial patient encounters.”

Full article at National Institute of Health

Professional Physical Therapy Expands In-Network Coverage Area with BlueCross BlueShield (Empire)

Professional Physical Therapy, a leading provider of outpatient physical therapy and rehabilitation services in the Northeast, announces today that it has expanded its in-network coverage area with Empire BlueCross BlueShield (Empire) to include more of their convenient locations with additional credentialed providers.

Empire is the one of the largest insurance providers in New York State, and approximately four million residents as well as 38,000 business, union, and small employers are insured by Empire. With this, Professional Physical Therapy is able to more closely meet the needs of these individuals, and provide them with more convenient access to superior services including physical, occupational, and hand therapy treatment.

Full article at Professional Physical Therapy

Navigating Home Modifications Billing for Medicare-Covered Clients

As the population ages, and the majority of older adults express a desire to age in place, the need for home modification evaluations and interventions is expanding. While home modification services are clearly within the scope of occupational therapy, what is not so clear are the options for reimbursement. Many questions arise regarding proper billing.

Medicare-covered clients are entitled, under law, to medically necessary services. Occupational therapy practitioners do NOT have the right, under current statutes, to “opt out” of Medicare. Any occupational therapy practitioner, even those who are not Medicare providers, must directly bill Medicare for any medically necessary skilled therapy services provided to Medicare-covered clients. Whether or not to bill Medicare for home modification OT services must be based on the occupational therapy practitioner’s clinical determination of whether the services are medically necessary.   

This guide first provides a brief overview of the occupational therapy practitioner’s role in home modification and the current Medicare program. Second, case scenarios are provided on some of the factors used in determining whether the services are medically necessary. It should be noted that the scenarios are only examples, and each case requires a unique determination. The occupational therapy practitioner is ultimately responsible for determining Medicare medical necessity for each client.

Full article at AOTA

Virtual PT after knee replacement provides good outcomes with lower costs

A virtual system for in-home physical therapy (PT) provides good outcomes for patients undergoing rehabilitation following total knee arthroplasty (TKA) – with lower costs than traditional in-person PT, reports a study in the January 15, 2020 issue of The Journal of Bone & Joint Surgery. The journal is published in the Lippincott portfolio in partnership with Wolters Kluwer.

“Relative to traditional home or clinic PT, virtual PT with telerehabilitation for skilled clinical oversight significantly lowered three-month health-care costs after TKA while providing similar effectiveness,” according to the clinical trial report by Janet Prvu Bettger, ScD, of Duke University, Durham, N.C., and colleagues.

Ready full article at News-Medical.net

Study finds dopamine, biological clock link to snacking, overeating and obesity

Coinciding with this increase in weight are ever-rising rates of heart disease, diabetes, cancer and health complications caused by obesity, such as hypertension. Even Alzheimer’s disease may be partly attributable to obesity and physical inactivity.

“The diet in the U.S. and other nations has changed dramatically in the last 50 years or so, with highly processed foods readily and cheaply available at any time of the day or night,” Ali Güler, a professor of biology at the University of Virginia, said. “Many of these foods are high in sugars, carbohydrates and calories, which makes for an unhealthy diet when consumed regularly over many years.”

In a study published Thursday in the journal Current Biology, Güler and his colleagues demonstrate that the pleasure center of the brain that produces the chemical dopamine, and the brain’s separate biological clock that regulates daily physiological rhythms, are linked, and that high-calorie foods — which bring pleasure — disrupt normal feeding schedules, resulting in overconsumption. Using mice as study models, the researchers mimicked the 24/7 availability of a high-fat diet, and showed that anytime snacking eventually results in obesity and related health problems.

Read full article at Science Daily

Earlier falls predict subsequent fractures in postmenopausal women

The risk of fracture in postmenopausal women can be predicted by history of falls, according to new findings from the Kuopio Osteoporosis Risk Factor and Prevention Study (OSTPRE) at the University of Eastern Finland. Published in Osteoporosis International, the study is the first to follow up on the association between history of falls and subsequent fractures.

Falls in the elderly are common, resulting in fractures and other serious health consequences. In people aged 65 years or over, falls are the leading cause of injury-related death and hospitalisation. Fall-induced injuries cause a substantial economic burden worldwide.

Conducted at the University of Eastern Finland and Kuopio University Hospital, the study comprised 8,744 women whose mean age at the beginning of the study was approximately 62 years. The study started in 1999 with an enquiry asking the study participants about their history of falls in the preceding 12 months. The researchers wanted to know how many times the study participants had fallen, what had caused the falls and how severe the falls had been; i.e., did they lead to injuries that required treatment. A follow-up enquiry was conducted in 2004, asking the study participants about any fractures they had suffered during the five-year follow-up. The self-reported fractures were confirmed from medical records.

Read full article at Eureka Alert