Congress Letter to CMS Re Payment Cuts for Outpatient Physical Therapy Services
As reported in Physical Therapy Products, on August 9, Rep Earl Pomeroy (D-ND) sent a letter signed by 68 members of Congress to Donald Berwick, MD, administrator of the Centers for Medicare and Medicaid Services (CMS). The letter expresses concern over CMS’s proposal to cut payment for outpatient physical therapy, occupational therapy, and speech-language pathology services in the CY 2011 physician fee schedule proposed rule.
The letter begins, “We write to you to express our concern over the significant cuts in payment for outpatient physical therapy, occupational therapy, and speech-language pathology services proposed by the Centers for Medicare and Medicaid Services (CMS) in the CY 2011 Physician Fee Schedule Proposed Rule.”
“The rehabilitation community strongly believes that a cut of 50 percent is unwarranted and is concerned that CMS’ proposed policy is based on a flawed assumption that there is duplication of services when rehabilitation services are billed. Therapy codes are unlike most other Current Procedural Terminology (CPT) codes in that the practice expense component for a typical visit is spread out among multiple codes since multiple services are typically provided to a patient during a visit,” says the letter.
The letter requests that a detailed explanation of the methodology CMS used to calculate the new rates be provided to Congress. Pomeroy also included a request that CMS work closely with stakeholders in the rehabilitation community toward the production of a final rule that will not adversely affect access to care, particularly in rural and other underserved areas.
“Given that this represents a significant cut to a group of services in the proposed Medicare Physician Fee Schedule and given the large number of Medicare beneficiaries who rely upon these therapies, we ask that CMS provide us with a detailed justification, including an explanation of the methodology used to calculate the new rates.”
2011 Proposed Physician Fee Schedule Rule Contains Proposed Pay Cuts for Outpatient Therapy Services
As reported by APTA.org, the Centers for Medicare & Medicaid Services (CMS) issued the proposed physician fee schedule rule that would implement key provisions of the Patient Protection and Affordable Care Act of 2010 and update payment rates under the physician fee schedule for services furnished on or after January 1, 2011 (CY 2011).
If this rule becomes effective, physicians, physical therapists and other health care professionals would receive a 6.1% cut to their Medicare payments starting January 1, 2011 in addition to the 21.3% reduction that has been delayed several times already this year due to the flawed Sustainable Growth Rate (SGR) formula. This reduction was replaced with a 2.2% update until November 30, 2010, when the President signed the “Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010″ on Friday, June 25.
In addition to the projected reductions due to the SGR, CMS also proposes a multiple procedure payment reduction policy (MPPR) that would result in significant reductions in payment for outpatient therapy services. Specifically, CMS proposes to make full payment for the therapy service or unit with the highest practice expense value and payment of 50 percent of the practice expense component for the second and subsequent procedures or units of the service furnished during the same day for the same patient. The work and malpractice components of the therapy service payment would not be reduced. The proposed multiple procedure payment reduction policy would apply to both the services paid under the physician fee schedule (PFS) that are furnished in the office setting and those services paid at the PFS rates that are furnished by outpatient hospitals, home health agencies (Part B), skilled nursing facilities (Part B), comprehensive rehabilitation facilities, and other entities that are paid by Medicare for outpatient therapy services. It is estimated that if the multiple procedure payment reduction policy were implemented, payment for outpatient therapy services would be reduced by approximately 13% in addition to the projected SGR payment cut for CY 2011.
The APTA believes that CMS’s proposal to apply the multiple procedure payment reduction to outpatient therapy services is based on flawed presumptions and has no justification. The APTA states that it will aggressively work to stop implementation of the proposed MPPR policy and the SGR payment reductions.
Just “Wright” or Just Plain Wrong?!
The President of the American Physical Therapy Association (APTA), R Scott Ward, PT, PhD, recently blogged about a movie that is getting both positive and negative attention in industry listservs.
“Just Wright,” in theaters May 14th, stars Queen Latifah as a physical therapist who — it appears from movie trailers — falls in love with and begins dating her NBA star patient. As this premise goes against the physical therapy Code of Ethics, much dialogue among PTs has been generated about Hollywood’s depiction of the profession.
The blog post covers what actions the APTA’s PR department has taken with the producers of the film to point out the eithical concern involving the plot. It also discusses a study from the April issue of the Journal of Medical Ethics to point out that the PT profession is not alone when it comes to entertainment industry portrayals that are less than accurate.
We suggest that you read the blog, see reactions from your colleagues and get involved in the dialogue prior too and after the movie is released on May 14th.
May is Better Hearing and Speech Month
The American Speech-Language-Hearing Association (ASHA) is promoting “Better Hearing and Speech” in the month of May. This annual event provides opportunities to raise awareness about communication disorders and to promote treatment that can improve the quality of life for those who experience problems with speaking, understanding, or hearing.
For resources to help your facility celebrate Better Hearing and Speech month, go to http://www.asha.org/bhsm/
House Passes Health Reform
On March 21, 2010, the United States House of Representatives passed H.R. 3590, the Patient Protection and Affordable Care Act. Also passed was H.R. 4872, the Health Care and Education Affordability Reconciliation Act, which contains additional refinements. Historically speaking, these two bills are perceived to be as important as the creation of the Medicare program.
Chart Links Participates in PT Products’ Software Roundtable
Jim Hammer, COO of Chart Links, was invited again this year to participate in a software roundtable interview with editor of Physcal Therapy Products, Arati Murti. Here are a few of the questions and answers that were exchanged in the January 2010 edition:
PT Products: Budgets are tight in today’s economy; what are practice managers focused on in terms of software features/needs?
Jim Hammer: They’re focused on what really counts-features that provide a tangible return on investment: Compliance in coding and charting that will reduce payor denials and audits; reduce lost charges and increase revenue opportunity; Denial and revenue cycle management that will increase cash flow; and Automation of manual workflow processes (like referral and plan of care management) to create operational efficiencies and reduce labor costs.
PT Products: In what features/business areas can managers save money/time? (What software features can be used differently or combined?)
Jim Hammer: By using software to reduce the phone calls and faxing associated with physician approval of therapist-generated plans of care, both time and money can be saved. At one of our hospital-affiliated outpatient centers, both therapists and physicians were documenting electronically. However, the authorization process between the two systems required manual intervention with printing, sorting, bundling, faxing, scanning, and data input. Chart Links created a real-time interface to eliminate the manual paper chase in the workflow. By eliminating backlogs of unauthorized paper plans of care, the client has delivered quicker continuity of care (time) and has reduced billing delays (money).
PT Products: What’s the most challenging business “bottleneck” that you hear of from your customers, and how can software help avoid that situation?
Jim Hammer: Plan of care authorization management is still a manually burdensome and paper-laden process in our industry. Time is lost making phone calls, printing, signing, faxing, and waiting for paper forms to be authorized. With a Health Level 7 (HL7) interface and workflow automation, this process can be transformed into the electronic age to avoid the unnecessary paper chase.
PT Products: In terms of software needs in 2010, what are the important differences in concerns for hospitals/facilities versus private practices?
Jim Hammer: Data exchange. Hospital-affiliated outpatient rehabilitation centers must focus on how they will connect to the hospital information system and to local area referring physicians via Health Level 7 (HL7) interfaces. Standards and definition around health information exchange will be critical in the coming year.
CMS & ONC Issue Regs Proposing Definition of Meaningful Use and Setting Standards for EHR
The Centers for Medicare & Medicare Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC) encourage public comment on two regulations issued on December 30, 2009 that lay a foundation for improving quality, efficiency and safety through meaningful use of certified electronic health record (EHR) technology. The regulations will help implement the EHR incentive programs enacted under the American Recovery and Reinvestment Act of 2009 (Recovery Act).
A proposed rule issued by CMS outlines proposed provisions governing the EHR incentive programs, including defining the central concept of “meaningful use” of EHR technology.
An interim final regulation (IFR) issued by ONC sets initial standards, implementation specifications, and certification criteria for EHR technology. Both regulations are open to public comment.
- The CMS proposed rule and fact sheets, may be viewed at http://www.cms.hhs.gov/Recovery/11_HealthIT.asp
- ONC’s interim final rule may be viewed at http://healthit.hhs.gov/standardsandcertification
The Recovery Act established programs to provide incentive payments to eligible professionals and eligible hospitals participating in Medicare and Medicaid that adopt and make “meaningful use” of certified EHR technology. Incentive payments may begin as soon as October 2010 to eligible hospitals. Incentive payments to other eligible providers may begin in January 2011.
New Payment Model for Anthem Blue Cross OTs in California
As reported by the Occupational Therapy Association of California (OTAC), occupational therapy practitioners within Anthem Blue Cross’ network of providers were recently notified of a planned change in Anthem Blue Cross’ payment methodology for the reimbursement of occupational therapy services in California.
This new payment model changes the current payment system to one where providers will be paid $75 per visit regardless of the treatment(s) provided or the intensity of those treatment(s).
As this change in reimbursement could prove to be financially detrimental to occupational therapy practice, the OTAC is encouraging all of its members to be a part of their grassroots advocacy effort to ensure cost-effective and quality occupational therapy services for Anthem Blue Cross clients. They have posted sample letters to use to educate executives at Anthem Blue Cross on the high value of occupational therapy services in promoting health and disability and to voice opposition to the $75 flat rate.
Meaningful Use for Therapists
So far, recommended meaningful use measures for electronic health records (EHR) have focused on primary care providers. Hopefully, that will change soon after the Health Information Technology (HIT) Policy Committee meets in Washington later this month. At the two-day meeting, the HIT Policy Committee will hear testimony on how meaningful use might affect non-physician practitioners.
Under the American Recovery and Reinvestment Act (ARRA), the Federal Advisory Committee Act (FACA) mandated the creation of the HIT Policy Committee. This committee is charged with making recommendations to the National Coordinator for HIT on issues pertaining to health information technology.
National Physical Therapy Month to Focus on Obesity
According to the American Physical Therapy Association (APTA), October is National Physical Therapy Month and its focus is on our national obesity epidemic.
For the nearly 100 million Americans who are overweight or obese, physical activity must be a crucial component to weight loss and better health. According to a recent study conducted by the Trust for America’s Health, a research group that focuses on disease prevention, obesity rates continued their climb in 31 states last year. Health officials say the latest state rankings provide evidence that the nation has a public health crisis on its hands. Last year, The Centers for Disease Control and Prevention cited evidence that found that more than 22 percent of Americans did not engage in any physical activity in the previous month.
Physical therapists develop fitness plans for both adults and children that promote the ability to move, reduce pain, restore function, and prevent disability. For those who are overweight or obese, physical therapists balance the progression of the exercise prescription with the need for joint protection and safety during exercise.
Consumers can find information about National Physical Therapy Month, whose theme is “Physical Therapy: The Science of Healing. The Art of Caring,” by visiting APTA’s newly designed and easily navigable Web page for the month-long celebration at http://www.apta.org/nptm.
Physical therapists are health care professionals who diagnose and treat individuals of all ages, from newborns to the elderly, who have medical problems or other health-related conditions that limit their abilities to move and perform functional activities in their daily lives. PTs examine each individual and develop a plan of care using treatment techniques to promote the ability to move, reduce pain, restore function, and prevent disability. Physical therapists also work with individuals to prevent the loss of mobility by developing fitness- and wellness-oriented programs for healthier and more active lifestyles.
The American Physical Therapy Association (http://www.apta.org) is a national organization representing 70,000 physical therapists, physical therapist assistants, and students nationwide. Its goal is to foster advancements in physical therapist education, practice, and research. Consumers can access “Find a PT” to find a physical therapist in their area, as well as physical therapy news and information at http:// www.apta.org/consumer.
RAC: CMS Approved Audit Issues Posted
To see the Recovery Audit Contractor (RAC) CMS-approved audit issues, visit Connolly Healthcare’s website. Connolly is the RAC Contractor for Region C. The CMS Approved Audit Issues are for hospital outpatient facilities and physicians.
According to the National Association of Rehab Providers and Associations (NARA), the first set of approved issues includes outpatient rehab in the mix, and the source of the issues comes straight from the finding in the RAC demonstration project in California and New York. In the demonstration project $3.2 million of claims for speech evaluation were found to be billed in error as time-based codes, rather than as service-based codes. The Speech evaluation code may only be billed as a unit of “1″. The same is also true for physical therapy evaluation and occupational therapy evaluation codes.
CCHIT to Seek EHR Vendor Input on Town Call Meeting
The Certification Commission for Health Information Technology (CCHIT®), a nonprofit organization with the public mission of accelerating the adoption of health IT, will host a Town Call tomorrow for the vendor and developer community tomorrow. Chart Links Chief Operating Officer, Jim Hammer, will participate. On the call, CCHIT will gather input on the details and timing of its planned new paths to certification of electronic health record (EHR) technologies, with the goal of supporting more rapid, widespread adoption and meaningful use under the American Recovery and Reinvestment Act of 2009 (ARRA).
“We are concerned that providers could not achieve meaningful EHR use in 2011 if they wait until Spring 2010 – the expected date of HHS final approval of requirements – to begin adopting this technology,” said Mark Leavitt, M.D., Ph.D., Commission chair. “CCHIT has analyzed the recommendations of the Federal HIT Advisory Committees and is preparing to offer new paths to certification beginning this October.”
Besides updating and enhancing its current certification program for comprehensive EHRs in Ambulatory, Inpatient, and Emergency Department settings, the Commission plans to launch a more limited, modular inspection program for EHR technology, focusing only on compliance with ARRA-required standards.
During the event, planned for September 3 at 12:00 PM Central time, concepts and some details of these two programs will be discussed. Participants will be invited to submit questions and comments online, and respond to polling regarding their interest and readiness for participation in the process.
Information about the free Town Call is available at http://www.cchit.org/about/towncalls/commission-seeks-input-2009.
More information on CCHIT and CCHIT Certified® products is available at http://cchit.org and http://ehrdecisions.com.
2009 Physical Therapist Productivity Report
Now available from the American Physical Therapy Association (APTA) for its members is the 2009 Physical Therapist Productivity Summary Report. The report provides actual data on the number of patients seen by PTs versus previous reports on productivity dealing with “expectations” of patients seen.
Therapists Now Required to Notify Individuals of Health Information Breaches
The U.S. Department of Health and Human Services (HHS) has issued a rule requiring that individuals be notified of breaches of their health information.
These “breach notification” regulations implement provisions of the Health Information Technology for Economic and Clinical Health (HITECH) Act, passed as part of the American Recovery and Reinvestment Act of 2009 (ARRA).
The regulations, developed by the HHS Office for Civil Rights (OCR), require health care providers and other HIPAA covered entities to promptly notify affected individuals of a breach, as well as the HHS Secretary and the media in cases where a breach affects more than 500 individuals. Breaches affecting fewer than 500 individuals will be reported to the HHS Secretary on an annual basis. The regulations also require business associates of covered entities to notify the covered entity of breaches at or by the business associate.
The regulations were developed after considering public comment received in response to an April 2009 request for information and after close consultation with the Federal Trade Commission (FTC), which has issued companion breach notification regulations that apply to vendors of personal health records and certain others not covered by HIPAA.
To determine when information is “unsecured” and notification is required by the HHS and FTC rules, HHS is also issuing in the same document as the regulations an update to its guidance specifying encryption and destruction as the technologies and methodologies that render protected health information unusable, unreadable, or indecipherable to unauthorized individuals. Entities subject to the HHS and FTC regulations that secure health information as specified by the guidance through encryption or destruction are relieved from having to notify in the event of a breach of such information. This guidance will be updated annually.
The HHS interim final regulations are effective 30 days after publication in the Federal Register and include a 60-day public comment period. For more information, visit the HHS Office for Civil Rights web site at http://www.hhs.gov/ocr/privacy/
No Final Definition of EHR Meaningful Use until Spring of 2010
We’ve been anxiously awaiting a final definition for “meaningful use” of electronic health records (EHR) to determine which hospitals and providers will be eligible for Medicare and Medicaid incentive payments under the American Recovery and Reinvestment Act of 2009. However, in a press conference on August 20th, Dr. David Blumenthal, the national coordinator for health information technology, predicted that the final definition will not be available until the middle or end of spring in 2010. A preliminary definition of “meaningful use” is scheduled to be issued by the end of 2009 with a 60-day comment period.
Federal Trade Commission Delays Red Flag Rules
The Federal Trade Commission (FTC) says that it will further delay enforcement of the “Red Flag” rules until November 1. The rules were to go into effect August 1.
Therapists who provide services to patients without requiring those patients to pay in full at the time of service will need to comply with Federal Trade Commission (FTC) Red Flag rules.
Red Flag rules require the development of a written Identity Theft Prevention Program. Medical identity theft refers to situations when someone uses a person’s name and other parts of their identity, such as insurance information, without the person’s knowledge or consent to obtain medical services or goods.
For more information and resources, go to APTA’s Identity Theft Web page or visit our blog post from July.
Red Flag Rule Enforced Effective August 1, 2009
Therapists who provide services to patients without requiring those patients to pay in full at the time of service will need to comply with Federal Trade Commission (FTC) “Red Flag Rules.” We blogged back in April that practices would need to comply with these rules effective May 1, 2009. It’s important to know, now, that — effective August 1, 2009 — the FTC will begin to enforce this rule.
Red Flag rules require the development of a written Identity Theft Prevention Program. Medical identity theft refers to situations when someone uses a person’s name and other parts of their identity, such as insurance information, without the person’s knowledge or consent to obtain medical services or goods.
The FTC has posted an article called “The ‘Red Flags’ Rule: What Health Care Providers Need to Know About Complying with New Requirements for Fighting Identity Theft,” by Steven Toporoff. The article covers off on
- Who Must Comply
- Spotting Red Flags
- Setting Up Your Identity Theft Prevention Program
- What’s At Stake
We suggest that a representative from your facility reads the article to come up to speed on compliance with this rule.
CCHIT Addresses EHRs for Inpatient Rehabilitation
A task force of the Certification Commission for Healthcare Information Technology (CCHIT) has issued recommendations for a new long term and post acute care electronic health records certification program.
The program would cover EHRs in skilled nursing and nursing facilities, Medicare-certified home health agencies, inpatient rehabilitation facilities and long term acute care hospitals.
Recommendations from the task force include identifying core certification criteria common to the four priority care settings, reusing or adapting existing criteria from other CCHIT programs, identifying additional criteria specific to each care setting, and developing a roadmap indicating when the criteria are expected to be implemented.
A newly appointed CCHIT work group on long term and post acute care will start developing certification criteria in mid-July. The recommendations from the task force are available at cchit.org/about/organization/commission/advisory/ltpac.
[Source: Information taken from HealthData Management, written by Joseph Goedert.]
Medicare Administrative Contractors (MAC) Fax Scam Alert
A 06/18/09 update on the Centers for Medicare and Medicaid Services (CMS) Home Health, Hospice & Durable Medical Equipment Open Door Forum website indicates that CMS has become aware of a scam. The scam entails the submission of faxes to practices from perpetrators posing as the Medicare carrier or Medicare Administrative Contractor (MAC). The fax tells physician staff to respond to a questionnaire to provide an account information update within 48 hours in order to prevent a gap in Medicare payments. The fax may have the CMS logo and/or the contractor logo to enhance the appearance of authenticity.
Medicare FFS providers, including physicians and non-physician practitioners, should be wary of this type of request. If you receive a request for information in the manner described above, please check with your contractor before submitting any information. Medicare providers should only send information to a Medicare contractor using the address found in the download section of the CMS.gov website found at http://www.cms.hhs.gov/MLNGenInfo/ or http://www.cms.hhs.gov/MedicareProviderSupEnroll .
AOTA Advocates for Medicare Home Health Flexibility Act (HR 1094)
According to the American Occupational Therapy Association (AOTA), current law limits the appropriate use of occupational therapy in the home health setting and negatively impacts outcomes for home health care recipients by barring clinically indicated and physician authorized services.
As an important step forward, newly proposed legislation would allow occupational therapists to conduct the initial assessment when there is a qualifying service on the physician order. This will allow home health agencies to more efficiently use their occupational therapists to meet patient needs.
Representatives John Lewis (D-GA) and Lincoln Diaz-Balart introduced legislation that would improve utilization of occupational therapy as a home health service under Medicare on February 13, 2009. The Medicare Home Health Flexibility Act (H.R.1094) is also actively supported by the National Association of Home Care and Hospice (NAHC), the American Speech-Language Hearing Association (ASHA) and was previously supported by the American Physical Therapy Association in the last Congress.
AOTA is working to build support for passage during the 111th Congress.