Tag: medicare

Two New Bills in House Focus on Expanding Telehealth in Medicare, Opening up Possibilities for PTs

Medicare could become a much more welcoming place for telehealth services if Congress passes 2 pieces of legislation recently introduced in the US House of Representatives. The 2 separate bills would have the combined effect of expanding where and how telehealth services can take place, which patients are permitted to receive the services, and the list of health care professional who can provide the services—a list that includes physical therapists (PTs).

The bills—1 called the Medicare Telehealth Parity Act, and a second known as the Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act—propose changes to the way Medicare handles a number of issues, from remote monitoring of patients with chronic conditions, to a reworked definition of reimbursable telehealth codes. In addition, the parity act expands the list of providers who can provide telehealth services to PTs, respiratory therapists, occupational therapists (OTs), speech language pathologists, and audiologists, while the CONNECT act would allow PTs in some bundled payment arrangements, accountable care organizations (ACOs), and Medicare Advantage plans to participate in telehealth arrangements.

Full story of expanding telehealth in Medicare at APTA

‘Locum Tenens’ for PTs Set to Begin in June

It’s official: starting June 13, physical therapists (PTs) in certain areas will be able to bring in another licensed PT to treat Medicare patients during temporary absences for illness, pregnancy, vacation, or continuing medical education, and bill Medicare for the services. And just as the new provisions begin, the old term for the concept—”locum tenens”—will be discontinued, according to the Centers for Medicare and Medicaid Services (CMS).

In a transmittal published May 12, CMS announced that “reciprocal billing and fee-for-time arrangements” under Medicare part B will be extended to PTs in health professional shortage areas (HPSA), medically underserved areas (MUA), or in CMS-designated rural areas (any area outside of a Metropolitan Statistical Area or Metropolitan Division). The change, triggered by the passage of the 21st Century Cures Act signed into law in December 2016, was 1 of APTA’s top public policy priorities.

Full story of locum tenens for PTs at APTA

Bill Introduced in House Would End Physician Self-Referral Loophole for Physical Therapy

Medicare self-referral loopholes—the exception that allows physicians to refer patients for physical therapy and other services to a business that has a financial relationship with the referring provider—is once again in the legislative spotlight on Capitol Hill.

On April 6, the Promoting Integrity in Medicare Act (PIMA) was reintroduced in the US House of Representatives (HR 2066), in hopes of eliminating the exception to the federal law originally intended to prohibit self-referral. That law, known as the Stark law, does prohibit most self-referral practices, but it also contains language that allows physicians to self-refer for “patient convenience” or same-day treatments—known as in-office ancillary services. Unfortunately those exceptions also include services that are rarely provided on the same day—physical therapy, anatomic pathology, advanced imaging, and radiation oncology.

Full story of the Promoting Integrity in Medicare Act at APTA

Analysis of Hospital System’s LE Joint Replacement Bundling Programs Reveals Significant Drop in Expenditures

In brief:

  • Analysis of Medicare payments related to 3,942 LE joint replacements in a 5-hospital network participating in voluntary bundling programs between 2008 and 2015.
  • During study period, average expenditures on replacements without complications dropped by 20.8%; expenditures on replacements with complications dropped by 13.8%.
  • Treatment population, severity of illness, and outcomes remained stable during study period; volume rose steadily.
  • Just over half (50.2%) of the savings were related to reduced in-hospital costs—predominantly due to a 30% reduction in the cost of implants. The remaining 48.8% of savings were related to a decreased use of IRFs and SNFs.
  • Use of home health care (including physical therapy in that setting) increased by 9% during study period.

It may be too soon to judge the cost-effectiveness of Center for Medicare and Medicaid Services’ (CMS) mandatory hip and knee replacement bundling programs, but if the experience of 1 hospital system that participated in earlier voluntary programs is any indication, facilities have reason to expect overall Medicare expenditures to drop, say authors of a new study. Their analysis of nearly 4,000 patients who participated in bundling programs between 2008 and 2015 revealed an average 20.8% reduction in expenditures for joint replacements without complications, with the bulk of those savings due to reduced implant prices and the decreased use of institutional postacute care.

Full story on the cost-effectiveness of hip and knee replacement bundling programs at APTA

Stay on Top of Medicare Changes With Latest APTA Fact Sheets

New, proposed, and revised rules from the Centers for Medicare and Medicaid Services (CMS) can come in waves, and when they do, it’s easy to feel awash in a sea of new regulations. Fortunately, APTA has resources to help you navigate your way to safe harbor: fact sheets that provide members with context and details on many of the final and proposed rule changes from CMS.

Here’s a quick rundown of some recent additions. Note: the links will take you to a general webpage on a particular topic—to access the members-only fact sheet, scroll down to the “APTA Fact Sheets and Summaries” header.

Home Health Conditions of Participation Final Rule
CMS brought its home health participation rule out of the 1990s by issuing its first revision to the rule in more than 20 years. The new rule establishes minimum standards for home health agencies that want to serve Medicare and Medicaid beneficiaries.

Full story on the top Medicare changes at APTA

New CPT Codes Result in Payment Increases From Medicare

A bit of good news for physical therapists (PTS): thanks to a change in the formula the Centers for Medicare and Medicaid Services (CMS) uses when calculating reimbursement, the new Current Procedural Terminology (CPT) code set for physical therapy evaluation and reevaluation is generating higher payments.

Just how much of an increase PTs are seeing depends on geographic region and whether the payment is for an evaluation or revaluation associated with a Medicare Part B beneficiary (APTA members will be able to identify if they will receive payment increases through an updated online Medicare payment calculator coming to the association’s website soon). Some commercial payers may also be affected by the changed formula, depending on how contracts are written.

Full story of new CPT codes result in payment increases from Medicare at Science Daily

Many IRF Patients Experience Interruptions in Care – About 10% Due to Preventable Conditions

New research into Medicare data has found that potentially costly interruptions in inpatient rehabilitation for neurological conditions may be occurring for as many as 1 in 3 patients, depending on the condition—and about 10% of all interruptions are related to complications that are considered preventable.

In an article e-published ahead of print in The American Journal of Physical Medicine and Rehabilitation, researchers analyzed data from nearly 80,000 Medicare beneficiaries admitted to an inpatient rehabilitation facility (IRF) for services related to stroke (71,769), traumatic brain injury (TBI; 7,109), and spinal cord injury (SCI; 659) between 2012 and 2013. Their analysis was focused on the prevalence and causes of 2 types of interruptions in care: “program interruptions,” wherein patients are transferred to another facility and returned to the IRF within 3 days; and “short-stay transfers,” in which patients are transferred to a hospital, skilled nursing facility (SNF), or other facility before their expected IRF length-of-stay ends.

Full story of IRF patients and interruptions in care at APTA

CMS Expands Mandatory Bundling Program to Cardiac Care, Including Rehab

The Centers for Medicare and Medicaid Services (CMS) has announced the latest in its move toward value-based payment systems—this time through the introduction of a mandatory bundling program for care associated with bypass surgery and heart attacks, including provisions that would incentivize the use of cardiac rehabilitation.

The demonstration plan announced by CMS would affect hospitals in 98 randomly selected metropolitan areas and would work much like the Comprehensive Care for Joint Replacement (CJR) model implemented this year. Similar to CJR, the new bundling plan would reimburse providers a set amount for an entire episode of care, from admission to 90 days after the patient is discharged. Medicare would create targets for spending, and if the total spending is less than the Medicare target, the hospitals may be eligible to receive additional payment from Medicare. If hospitals spend more than the Medicare target, they could be required to pay back Medicare for some portion of the difference. And like CJR, the cardiac bundling plan is mandatory for hospitals in those areas.

Full story of CMS bundling program to cardiac care at APTA

Anti-Identity Theft Changes to Medicare Cards Coming

How might changes to Medicare card numbers affect your practice? The Centers for Medicare and Medicaid Services (CMS) has some thoughts, but would like your input, too.

On Wednesday, July 27, CMS will host a “listening session” to discuss its social security number removal initiative (SSNRI), a plan to end Medicare card numbers that are based on a beneficiary’s social security number. The change is mandated under the 2015 Medicare Access and CHIP Reauthorization Act (MACRA) as a way to reduce opportunities for identity theft.

The session will run from 1:00 pm to 4:00 pm, ET, and will include a presentation on the SSNRI by CMS staff as well as a question-and-answer period. Registrants will be sent the CMS presentation in advance.

Full story of anti-identity theft changes to Medicare cards at APTA

Medicare Fraud Dragnet Identifies a Record $900 Million in Illegal Billing

The federal government has announced the largest-ever Medicare fraud sweep, a takedown that involves 301 individuals connected to alleged fraudulent billing totaling $900 million.

The defendants were announced by the US Justice Department on June 22 on charges including conspiracy to commit health care fraud, violations of antikickback laws, money laundering, and aggravated identity theft. In addition to violations connected to home health care, fraud charges were also associated with psychotherapy, durable medical equipment, drug prescribing, occupational therapy, and physical therapy. Home health-related fraud represents about 50% of the cases, with pharmacy fraud accounting for 25%.

The sweep was led by the Medicare Fraud Strike Force in 36 federal districts, but also included 23 state Medicare fraud control units and cases brought by 26 US Attorney’s offices. In terms of payments based on fraudulent claims, a CNN report shows that Florida led the list with $237 million, followed by Texas at $193 million, California with an alleged $162 million, and Michigan at $114 million. Other states associated with larger payment amounts were Illinois ($12 million) and New York ($86 million). The remaining $96 million was spread out over other states.

Full story of Medicare fraud billing at APTA