Tag: Centers for Medicare and Medicaid Services

New HHA Medicare, Medicaid Participation Requirements Won’t Launch Until January 2018

It’s now final: the US Centers for Medicare and Medicaid Services (CMS) has suspended startup of revised conditions of participation (CoP) for home health agencies (HHAs) until January 13, 2018. The new CoP originally were set to begin on July 13 of this year.

According to CMS, the updated minimum standards for HHAs that serve Medicare and Medicaid would strengthen patient rights, encourage more effective communication between patients and caregivers, and result in better outcomes reporting. HHAs had expressed concerns that they didn’t have enough time to prepare for the changes.

Full story on CMS and HHAs participation requirements at APTA

CMS Clears Up Error in Description of Which CPT Code Combinations Won’t Receive Full Payment

Apparently, physical therapists (PTs), occupational therapists (OTs), and the outpatient facilities they work for aren’t the only ones adjusting to the new Current Procedural Terminology (CPT) tiered coding set: recently, the Centers for Medicare and Medicaid Services (CMS) informed APTA that it’s revising its National Correct Coding Initiatives “procedure to procedure” edits, a long list of CPT code pairs that should not be reported together. That list of problematic paired codes included PT and OT evaluation and reevaluation codes.

It’s a complicated situation, but the bottom line is, CMS is making changes that should allow for full payment of PT and OT evaluation and reevaluations code combinations that previously resulted in erroneous payment denials or partial payment when the new code set was first adopted in January. Ironically enough, it appears the change is an attempt by CMS to correct an error in its National Correct Coding Initiative. Here’s a breakdown.

Full story of the new Current Procedural Terminology (CPT) tiered coding set at APTA

Inpatient Payment Proposed Rule Calls for $3 Billion Increase to Acute Care Hospitals, Reductions for Long-Term Care Hospitals

Acute care hospitals (ACHs) could receive a 2.9% increase in payment rates next year and see a relaxation in some reporting requirements related to electronic health records (EHRs) if a proposed rule from the Centers for Medicare and Medicaid Services (CMS) is rolled out as-is. The losers in the equation? Long-term care hospitals (LTCHs), which could face a 3.75% payment cut under the proposal.

The inpatient prospective payment system (IPPS) proposed rule released last week (CMS fact sheet here) covers a range of areas related to how ACHs and LTCHs would operate in relation to Medicare and Medicaid beneficiaries. Here are a few highlights of the proposed rule:

The proposed 2.9% ACH payment increase amounts to a $3 billion increase. Last year the increase was 0.95%.

Full story of new inpatient payment proposed rule at APTA

CMS Puts the Brakes on Unpopular ‘Pre-Claim’ Demonstration, Delays Conditions of Participation Update for Home Health

Good news for home health agencies (HHAs) and the physical therapists who work in those settings: the Centers for Medicare and Medicaid Services (CMS) is suspending its plans to expand a required pre-claim review process and is putting its sole demonstration on hold in Illinois for at least 30 days. The agency has also decided to hold off on implementing revisions to conditions of participation for HHAs.

The announcement from CMS arrived just as the agency was scheduled to include Florida as the second state in a 5-state audition of a system requiring HHAs to submit supporting documentation for services while beneficiaries are receiving care. The proposal was largely opposed by HHA organizations, who view the requirement as an excessive administrative burden. CMS announced the suspension on March 31, 1 day before HHAs in Florida were set to begin the pre-claim demonstration.

Full story of a required pre-claim review process at APTA

APTA to CMS: Proposed Orthotics and Prosthetics Rule Hurts Patients, PTs

When it comes to a proposed rule from the Centers for Medicare and Medicaid Services (CMS) that would impose undue regulatory and financial burdens on physical therapists (PTs) who provide custom orthoses and prostheses, APTA isn’t mincing any words, describing the proposed standards as a set of unnecessary requirements that will limit patient access to appropriate care.

In a March 10 letter to CMS, APTA President Sharon L. Dunn, PT, PhD, lays out the case for CMS to back away from the proposed rule, which would require PTs to be “licensed by the state [as a qualified provider of prosthetics and custom orthotics], or … certified by the American Board for Certification in Orthotics and Prosthetics … or by the Board for Orthotist/Prosthetist Certification.” APTA estimates that the additional administrative and financial burdens could affect thousands of PTs across the country.

Full story of CMS proposed orthotics and prosthestics rules at APTA

Interactive Map From CMS Lays Out PT and OT Market Saturation

Physical therapists (PTs) and occupational therapists (OTs) in Polk County, Texas—county seat Livingston—must not get much sleep, because according to the Centers for Medicare and Medicaid Services (CMS), between 2015 and 2016, CMS has paid claims related to an average of 249.3 users per provider. Out in big sky country, however, things are a little different: if you happen to be a PT or OT in Broadwater County, in central Montana, PTs and OTs averaged only 26 users per provider during the same time period.

That’s just a taste of some of the data available in the latest update to the CMS “market saturation and utilization data tool,” an interactive map that pulls from data used by CMS to, among other things, gauge potential fraud, waste, and abuse by getting a fairly granular sense of provider numbers and beneficiaries served. CMS says that it makes these data public “to assist health care providers in making informed decisions about their service locations and the beneficiary population they serve.” Physical therapy and occupational therapy data are tied to Medicare Part B claims.

Full story of PT and OT market saturation at APTA

New LTC Facility Rule Addresses Respiratory Therapy, Physical Therapy Orders, Compliance, More

After nearly a quarter-century of leaving things mostly untouched, the Centers for Medicare and Medicaid Services (CMS) has officially updated its rule on long-term care (LTC) facilities, adding provisions around respiratory therapy, physician delegation of therapy orders to physical therapists (PTs), and compliance, among other areas.

The changes set to take effect November 28 affect both therapy services and facility procedures. APTA has produced a fact sheet that details the changes (look under “APTA Summaries and Fact Sheets”), but here are a few quick takes:

PTs may be able to write therapy orders—with permission.
Although the new rule identifies physicians, physician assistants, nurse practitioners, and clinical nurse specialists as the providers empowered to give orders for a new resident’s immediate needs, the ability to write therapy orders for PTs or other qualified therapists to carry out may be designated to a PT.

Full story of the new long-term care facilities rule at APTA

SNF, IRF Final Rules Increase Payment—And Reporting Requirements

In final rules for 2017, the Centers for Medicare and Medicaid Services (CMS) has followed through on its proposed push for more quality reporting and new payment models for skilled nursing facilities (SNFs) and inpatient rehabilitation facilities (IRFs). Those rules, issued last week, also include a 2.4% increase in payments to SNFs, and a 1.9% increase for IRFs.

APTA has created summaries of the rules, available online (for the SNF final rule visit APTA’s Medicare Payment and Policies for Skilled Nursing Facilities pageand look under the “APTA Summaries” header; for the IRF final rule, visit the APTA Medicare Payment and Policies for Hospital Settings page, and scroll down to the “APTA Summaries” section under “Inpatient Rehabilitation”). Here are some of the highlights.

Full story of SNF and IRF final rules increase payment at APTA

Proposed Home Health Rule Includes Planned $180 Million Reduction, Shift to Cost-per-Unit System for Outlier Payments

The Centers for Medicare and Medicaid Services (CMS) has issued a proposed rule for the 2017 Medicare home health prospective payment system (HH PPS) that would continue a planned series of cuts that began in 2014, with an estimated overall 1% reduction, or about $180 million, scheduled for next year. The proposal, released on June 27, also includes a move away from cost-per-visit in favor of a cost-per-unit system for outlier payments, a plan to make separate payments for negative pressure wound therapy (NPWT) devices, and refinements to a value-based purchasing model used in 9 states.

APTA regulatory affairs staff is reviewing the proposed rule and will submit comments on the proposal to CMS. PT in Motion News will publish a report summarizing those comments; in the meantime, here are some key features of the changes that may be happening next year.

Full story of proposed HH PPS to reduce costs at APTA

CMS Offers Training on Coming IRF Changes

Changes to reporting requirements for inpatient rehabilitation facilities (IRFs) are coming this fall, and the Centers for Medicare and Medicaid Services (CMS) is helping providers prepare.

Now available for free download from CMS: presentation slides from a recent 2-day workshop that explored the ways that reporting on everything from functional abilities to falls will change under rules that implement portions of the Improving Medicare Post-Acute Care Transformation (IMPACT) Act. That law, passed in 2014 and supported by APTA, seeks to standardize data collected across postacute health care settings. The new reporting requirements begin October 1, 2016.

Originally presented as a “train-the-trainer” event in mid-May, the meeting’s agenda and all slides can be found by scrolling down the CMS IRF Quality Reporting Training webpage to the Downloads section. The compressed files, all pdf versions of PowerPoint slides, are labelled “IRF Training” 1, 2, and 3. Recordings of the training sessions will be posted to the CMS YouTube site in several weeks.

Full story of training on inpatient rehabilitation facilities changes at APTA