Tag: Centers for Medicare and Medicaid Services

CMS Will Test Payment Increases to Selected SNFs

In its continuing search for ways to reduce avoidable hospitalizations among skilled nursing facility (SNF) patients, the Centers for Medicare and Medicaid Services (CMS) will test a new payment system that would increase some payments and reward multidisciplinary care planning.

The test, set to launch in the fall of 2016, would increase payments to physicians conducting a comprehensive assessment in an SNF to the same amount they receive for providing the assessment in a hospital, according to a CMS news release. The new model would also provide new payments to practitioners “for engagement in multidisciplinary care planning activities,” and for treatment of 6 conditions that CMS says are linked to 80% of avoidable hospital admissions: pneumonia, dehydration, congestive heart failure, urinary tract infections, skin ulcers, and asthma.

CMS plans to select approximately 250 SNFs to participate in the model, which will apply to both Medicare and Medicaid beneficiaries.

Full story of CMS testing a new payment system at APTA

From PT in Motion Magazine: Get the Basics on CMS Bundling Program for TKA, THA

Remember, back last year, when the Centers for Medicare and Medicaid Services (CMS) said it would be moving from fee-for-service models and toward more outcomes-based payment systems? It wasn’t kidding.

This month in PT in Motion magazine’s “Compliance Matters” column: the publication’s first detailed look at the coming Comprehensive Care for Joint Replacement (CJR) model. The CJR, which will be mandatory in 67 metropolitan statistical areas, will require that hospitals engage in bundled care systems for total knee arthroplasty (TKA) and total hip arthroplasty (THA).

The basic idea is that in many parts of the country, CMS will assign a single rate for the entire episode of care for its Medicare beneficiaries who receive TKA or THA, from admission through rehab. Although providers will continue to be paid under their respective payment systems, at the end of the year, CMS will reconcile the payments against the total episode rate. Depending on whether the total payments are above or below that rate, the hospital could be eligible for additional payment—or (in the years to come) be required to pay back CMS. But there’s much more to it than that.

Full story of CMS bundling program for TKA and THA at APTA

PQRS Penalty Letters Require Quick Action From PTs

If you recently received a Physician Quality Reporting System (PQRS)-related penalty notice from the Centers for Medicare and Medicaid Services, you’re not alone. But you need to take action before a November 23 deadline.

APTA is aware that some members have received letters related to PQRS performance during 2014. If you believe you have received a penalty notice letter in error, be sure to submit an informal review request through the CMS “QualityNet” website by Monday, November 23.

CMS has informed APTA that providers have been experiencing problems in reaching QualityNet over the past several days, and says that it’s attempting to fix the problem. APTA is also working with CMS to ensure that physical therapists are not unduly penalized for 2014 PQRS performance.

Full story of PQRS penalty letters at APTA

Detailed Summaries Now Available on New CMS Rules for 2016

The final 2016 rules recently released by the Centers for Medicare and Medicaid Services (CMS) have been analyzed by APTA regulatory affairs staff, and the following summaries are now available:

Physician Fee Schedule
The final rule for the 2016 physician fee schedule includes a slight overall payment increase, the expansion of several quality measures, and continued examination of potentially “misvalued” current procedural terminology (CPT) codes, including 10 related to physical therapy.
Full APTA summary of final rule; PT in Motion News article with highlights.

Home Health Prospective Payment System
The final home health rule includes an estimated overall 1.4% payment reduction that’s smaller than the reduction originally proposed, and the introduction of a new value-based model that will be used in 9 states.
Full APTA summary of final rule; PT in Motion News article with highlights.

Fore more information on the new CMS rules for 2016, visit APTA

CMS Puts Unpopular Lower-Limb Prostheses Proposal on Hold

After receiving widespread criticism from patients, advocates, and groups including APTA, the Centers for Medicare and Medicaid Services (CMS) has announced that it will back away from a proposal that would have imposed significant restrictions on lower-limb prostheses. Instead, CMS will convene a work group of federal agency experts to look at best practices and access.

The CMS announcement comes after its review of public comments on a proposal developed by the durable medical equipment administrative contractors (DME MACs) to impose extensive restrictions on who could receive a lower-limb prosthesis, what kind (or kinds) of prosthesis they could get, and under which conditions Medicare would pay for the devices. APTA and other critics of the proposal argued that the proposal was not rooted in an understanding of rehabilitation, and that it ignored the importance of clinical judgment. APTA’s letter submitted to the DME MACs also warned that, if adopted, the rule could lower quality of care while increasing costs.

Full story of lower-limb prostheses proposal on hold at APTA

Home Health Payment for 2016 Includes New Value-Based Model, Slightly Smaller Reduction From Proposed Rule

The Centers for Medicare and Medicaid Services (CMS) has issued a final rule for the 2016 Medicare home health prospective payment system (HH PPS) that looks a lot like the rule it proposed earlier this year: a set of changes that includes an estimated overall 1.4% payment reduction smaller than the reduction originally proposed, and the introduction of a new value-based model that will be used in 9 states.

APTA regulatory affairs staff is reviewing the final rule and will develop a more detailed summary of its provisions in the coming weeks. In the meantime, here are some key features of the changes that will be happening next year.

Payment. Overall, CMS projects that payment adjustments will result in an estimated 1.4% reduction, or $260 million in 2016. This is a slight decrease from the proposed rule, which estimated a 1.8% overall reduction. CMS arrived at the overall estimate by weighing a 1.9% payment update against various decreases including reductions in the 60-day episode payment rate, per-visit payment rates, and nonroutine medical supplies. The rule also includes cuts in each of 2016 and 2017 to account for estimated case mix growth.

Full story of new home health payment method for 2016 at APTA

No New Problems Uncovered in Latest ICD-10 Testing

With the official startup date looming and the last dry run complete, the Centers for Medicare and Medicaid Services (CMS) says that at least from its end of things, all systems are go.

In its latest summary of end-to-end testing of ICD-10 codes in its reporting systems, CMS reported that the July 20-24 tests did not uncover any new issues with the fee-for-service claims processing systems, and that there were no claims rejections made “due to front-end CMS systems issues.”

“Overall, participants … were able to successfully submit ICD-10 test claims and have them processed through Medicare billing systems,” CMS states in its report. “The acceptance rate for July was similar to rates in January and April, but with an increase in the number of testers and claims submitted.”

Full story on the latest ICD-10 testing, visit APTA