The Medicare Fraud Strike Force charged 111 defendants in nine cities for their alleged participation in Medicare fraud schemes involving more than $225 million in false billing. As released by The United States Department of Justice, there were a number of physical and occupational therapists indicted (an indictment is merely a charge and defendants are presumed innocent until proven guilty).
The Medicare Fraud Strike Force is a multi-agency team of federal, state, and local investigators designed to combat Medicare fraud through the use of Medicare data analysis techniques and an increased focus on community policing.
The defendants charged are accused of various health care fraud-related crimes, including conspiracy to defraud the Medicare program, criminal false claims, violations of the anti-kickback statutes, money laundering and aggravated identity theft. The charges are based on a variety of alleged fraud schemes involving various medical treatments and services such as home health care, physical and occupational therapy, nerve conduction tests and durable medical equipment.
According to court documents, the defendants charged participated in schemes to submit claims to Medicare for treatments that were medically unnecessary and oftentimes, never provided. In many cases, indictments and complaints allege that patient recruiters, Medicare beneficiaries and other co-conspirators were paid cash kickbacks in return for supplying beneficiary information to providers, so that the providers could submit fraudulent billing to Medicare for services that were medically unnecessary or never provided. Collectively, the doctors, nurses, health care company owners, executives and others charged in the indictments and complaints are accused of conspiring to submit a total of more than $225 million in fraudulent billing.
The Medicare Fraud Strike Force operations are part of the Health Care Fraud Prevention & Enforcement Action Team (HEAT), a joint initiative announced in May 2009 between the Department of Justice and HHS to focus their efforts to prevent and deter fraud and enforce current anti-fraud laws around the country.
Since their inception in March 2007, Strike Force operations in nine districts have charged more than 990 individuals who collectively have falsely billed the Medicare program for more than $2.3 billion. In addition, the HHS Centers for Medicare and Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.
To learn more about the Health Care Fraud Prevention and Enforcement Action Team (HEAT), go to: www.stopmedicarefraud.gov.
One of our Chart Links Rehabilitation Software users, Debbie Flaspohler, OTR, MOT, CLT and manager of occupational therapy at Margaret Mary Community Hospital in Batesville, Ind., was recently quoted in an article called “Meaningful Change,” written by Teresa Mcusic from TodayInOT.com. Reveiw some of her quotes extracted below, or, read the full article.
Debbie Flaspohler, OTR, MOT, CLT, manager of occupational therapy, Margaret Mary Community Hospital in Batesville, Ind., says she was comfortable using her facility’s Chart Links LLC rehabilitation software within a few weeks. “It was an easy program to move around in,” she says. “And Chart Links did a good job of coming and doing orientation. A team came and spent about a week with us. Also, they have a help desk, so when we got stuck, we could call them.”
The legibility and standardization of electronic records are major benefits over hand-written paper charts, therapists say. The electronic documentation also is more concise, Flaspohler says. “It looks more professional,” she says. “These are a legal document used for reimbursement. Clarity and accuracy are really important.”
Such precision also helps with more consistency among healthcare team members, Flaspohler says. “It helps everybody document the way they are supposed to,” she says. “It’s not black and white — you can modify the way you want to — but it makes you fill out what you need to fill out.”
The systems also can be tailored to include information on interventions for patients with conditions the therapists don’t often encounter, Flaspohler says. “For diagnoses you normally don’t see, you can pull in components from the system for a segment on that,” she says.
For more information about Chart Links Rehabilitation software for occupational therapists, visit our website.
Chart Links offers physical therapy documentation software designed to match the workflow of a physical rehabilitation facility.
In addition to administrative and financial features like patient registration, referral management, insurance authorization, cross-discipline scheduling, charges, reporting/analytics, and outcomes, Chart Links offers the following physical therapy-specific features.
- PT Evaluations. Standard physical therapy documentation and evaluation forms library (i.e., cervical spine, shoulder, ankle). Contains numerous sections with the ability to customize into sets and forms.
- PT Flow Sheets. Electronic management of daily flow sheets (i.e., shoulder therex, exercise) with ability to analyze progress over time. Ability to link flow sheets to progress notes.
- Scheduling. Ability to schedule patient with PTA and PT in one easy-to-use feature.
- Patient Arrival Notification. Using our physical therapy documentation software, PT may receive a page on his/her beeper to be notified when a patient has checked in at the front desk.
- Wireless Access. Allows for un-tethered documentation (i.e., document in a wireless gym setting with hardware on a rolling cart, or, use a handheld wireless tablet PC).
- PT Patient Education. Print-on-demand patient handouts (i.e., home programs, exercises). Instructional and educational materials are available for customization and distribution. Ability to scan-in existing sheets or create-your-own. Ability to interface to third-party electronic formats.
- Authorizations. Monitor authorized visits for PT evaluation and follow-up visits.
- Compliance. Support of compliance efforts with JCAHO, CARF, HIPAA and other rehabilitation professional standards. Helps ensure compliance with Medicare CCI edits, modifiers and time tracking while documenting.
For more information, visit Chart Links at www.chartlinks.com
Three Senate committee chairmen asked the Department of Health and Human Services Inspector General to look into potential conflicts of interest among private sector contractors that perform many of the payment, administration and oversight functions of Medicare.
The chairmen say that a recent survey of contractors conducted by their staffs to examine problems within the Medicare program identified several relationships between key Medicare contractors “that raise questions about possible conflicts of interest, or at the very least, might present the appearance of a conflict of interest.”
In some instances, the oversight contractor is a subsidiary of a company with a Medicare claims processing contract; in other instances, the claims contractor is a subsidiary of a parent company that also has a subsidiary with an oversight contract.
Congressional staffers said they have been reviewing the relationship of subsidiaries of WellPoint Inc., Hewlett Packard Co’s EDS Corp., and several other Medicare contractors hired by the government to monitor the bills healthcare providers send to Medicare, according to media reports.
[Extracted from: Fierce Healthcare]
Each year in April, occupational therapists, occupational therapy assistants, and students in practice, education, research, and science host a month long celebration showcasing the importance of Occupational Therapy. It’s the time of year when everyone in the profession goes out of their way to tell the world about what they do.
If you’re looking to participate in OT Month, the American Occupational Therapy Association (AOTA) has made a number of tools available to make your organizing efforts a little easier. Check out www.aota.org for more information, or, go to www.promoteot.com.
An article summarizing how Chart Links Rehabilitation Software streamlined the clinical and financial operations of an outpatient rehab practice recently got published in the Jan/Feb 2011 Rehab Management magazine. Read the full article below or link to it here.
by Andrea Marchi, PT, MBA, CSCS
EMR streamlines rehab practice’s clinical and financial operations.
Many therapists are considering the implementation of electronic medical record (EMR) solutions, but hesitate on making the purchase because they aren’t sure exactly how the technology will help their practice.
Our practice had the same concern initially, so we thoroughly evaluated the areas where an EMR could improve our business. It was quickly apparent that paper-based processes had a stranglehold on our practice. We suffered from many of the challenges other practices experience, such as: misplaced patient records; incomplete, untimely documentation impacting the billing process or regulatory compliance; productivity and financial performance data that was several months old by the time it was compiledWith the industry steadily moving toward widespread adoption of EMRs, we wanted to get ahead of the curve. Our facility, HealthPoint Rehab, which is affiliated with Southeast Hospital, handles about 33,600 patient visits annually out of two outpatient rehabilitation centers located in Cape Girardeau and Jackson, Mo.
There are numerous EMRs designed for physician practice specialties, but few that address the specific needs of rehab centers. We found a system designed to accommodate our team of 25 therapists engaged in physical, occupational, speech, and specialty therapies. Our system automates workflow for cross-discipline scheduling, referrals, insurance authorizations, clinical documentation, charges, and more. It includes Health Level 7 (HL7) interfaces to our hospital information system for effortless exchange of data. Most importantly, it supports our efforts to comply with professional standards while running an efficient business.
After a comprehensive system selection process, we implemented a software system in January 2009. The following information details how the technology has helped our organization over the past 2 years.
The biggest benefit we immediately noticed was the timely documentation of patient treatments. We have desktop computers installed within private exam rooms and laptop carts in our open gym spaces. Most of our therapists complete the treatment notes during the patient visit, while others finish after the visit.
In contrast, it took us much longer to get our initial evaluation paperwork to the physicians’ offices when we relied on dictation, transcription, and snail mail. We used to employ a full-time transcriptionist, but we have since eliminated the position and use the system’s faxing software to electronically fax our documentation to the physicians.
The structure of our daily notes within the software system has allowed our therapists to document procedures in a very clean and concise format. Another benefit is that our software system can ensure compliance with insurance regulations and therapy standards. During the documentation process, the system alerts therapists if they do not complete sections of the note that are necessary to comply with requirements from Medicare and The Joint Commission.
Using the EMR has helped us improve our billing process. Since charts are electronic and always available to the billing specialists when they need them, we complete our billing in a much more timely manner. We no longer waste time searching for the paper chart.
Unlike most EMRs, our rehab-specific solution has therapy-based billing capabilities built right into it. Correct coding initiative (CCI) edits built into the system help prevent errors that can result in returned claims or rejections from payors. The latest CCI edit table is automatically downloaded into the charge table, so we are always working from the most current version. Our system automatically reviews charges as they are being entered and alerts users if charges are improperly grouped or are missing modifiers. Using the system gives us the confidence that we are doing our billing correctly the first time, so we don’t have to worry about rebilling later in order to fix errors.
Further assisting our billing efforts is an interface that connects the system to the Meditech hospital information system at Southeast Missouri Hospital. The interface allows the systems to exchange information for billing and results, as well as admission, discharge, and transfer data. The result is a reduction in duplicate data entry.
The tracking capabilities of the EMR also help with compliance, especially when it comes to ensuring that physicians sign plans of care following initial patient evaluations. The system’s reporting capabilities enable therapists and front-office workers to easily view all plans of care that have not been signed by physicians, which helps accelerate follow-ups. And in cases where physician signatures have not been obtained, it tracks the number of times the plan of care was faxed by the system to a physician for signature. This tracking capability helps rehab clinics demonstrate their due diligence in trying to obtain signatures, which is Medicare compliant.
Prescriptions for therapy are also tracked. Upon receiving a physician’s prescription for therapy, it is entered into the system along with the number of visits that are prescribed or allowed by insurance. It also reports patients who have prescriptions that are about to expire, so the front-office can ensure we continue to treat patients with a current prescription.
A simple-to-use ad hoc analysis tool enables us to analyze practice trends, develop universal metrics, measure long-term changes, and gather operational decision-support data. Using the EMR’s analytics package, we have been able to analyze cancellation rates by patient type, determine our top referral sources by physician or physician group practice, track the number and type of CPT code charges, as well as proactively monitor staff productivity.
For example, by using the analytics module, we discovered that pediatric speech patients had the highest number of visit cancellations. Each cancellation negatively impacts our revenue and therapist productivity, so we developed new cancellation policies—applied to all patient types—to help curb the problem. By making patients aware of the new policy, we have been able to decrease our cancellation rate from 18% to 13%.
We also use the analytics module to track therapist productivity based on hours worked and units billed. In the past, we had one of our secretaries compile data to measure therapist productivity, but the process was cumbersome, and results were not available for 2 to 3 months after the time frame measured. Now, productivity is calculated weekly, so therapists can proactively monitor their productivity, which has been a wonderful management tool.
Another area we monitor with the analytics module is tracking referral sources. We can see exactly which physicians and physician clinics refer the most patients to us, which guides us in building relationships and growing our business.
The productivity of our front-office has been greatly improved by using the new system’s electronic scheduling capabilities. Now, scheduling is easy; as information can be clicked, dragged, copied, and pasted rather than entered manually. Also, scheduling multiple visits can be done all at once instead of creating individual appointments.
Front-office productivity is further enhanced by the system’s automated paging capabilities. Upon patient check-in, the system automatically sends an alphanumeric page to the corresponding therapist to let them know that the patient has arrived. Previously, the receptionist manually dialed the therapist’s numeric pager and during busy periods, it would be several minutes following the patient’s arrival before the secretary was able to send the page. In a business that bills based on time and units, a 3- to 5-minute delay can be the difference of billing an additional unit of service. In that regard, something as simple as automated paging may eventually lead to increases in revenue for us.
The EMR we selected has complemented our workflows and helped our practice improve productivity and documentation.
The most vital component to our successful EMR usage is that we selected a solution designed to operate in our business environment. The system’s rehab-specific capabilities allow our practice to automate the processes that matter most to our business. After using the solution for nearly 2 years, we can’t imagine doing our jobs without it.
Andrea Marchi, PT, MBA, CSCS, is the rehab manager at Southeast Missouri Hospital, HealthPoint Rehab, Cape Girardeau, Mo.
Chart Links, a leading provider of workflow management software for medical rehabilitation, has developed a data exchange with FOTO’s Patient Inquiry® (PI®) software. This Health Level 7 (HL7) interface virtually eliminates redundant data entry by automatically populating information entered into Chart Links directly into FOTO’s Patient Inquiry software.
FOTO, or Focus On Therapeutic Outcomes, Inc., is the nation’s largest independent outpatient database and reporting service for physical rehabilitation providers. FOTO provides an external, standardized, comparative database management and reporting service.
Chart Links’ interface to FOTO offers therapists a convenient way to get at functional and demographic data that will support decisions to maximize clinical efficiency. By measuring performance against therapists all over the country, outpatient rehabilitation facilities can identify strengths and weaknesses to target areas for the improvement of clinical practice and continuing education of staff. They can also gain access to information that will allow their facility to
- better market its services
- track outcomes of referral sources
- negotiate contracts with payers
- better understand its patients
For more information, contact Robert Stafford at Chart Links.
The American Society of Hand Therapists (ASHT), based in Chicago, is a professional organization comprised of licensed occupational and physical therapists who specialize in the treatment and rehabilitation of the upper extremity (hands, shoulders, arms, and elbows). This not-for-profit organization has over 3,000 members. ASHT’s mission is to advance the specialty of hand therapy through communication, education, research, and the establishment of clinical standards. Learn more at www.asht.org.
Paul R. Rao, PhD, CCC-SLP, recently took office as the 2011 president of the American Speech-Language-Hearing Association (ASHA), the national professional, scientific, and credentialing association for audiologists, speech-language pathologists, and speech, language, and hearing scientists.
Rao, 64, is vice president of operations and compliance at the National Rehabilitation Hospital, Washington, DC, and a visiting professor at the University of Maryland. Rao succeeds Tommie L. Robinson Jr, PhD, CCC-SLP, who continues to serve on ASHA’s board of directors.
“My goal is to better position ASHA members to serve their clients and to improve reimbursement and access for all,” Rao said. “As part of that, as ASHA’s president I look forward to working with ASHA member-advocates to see that the Association continues to be a significant player in the new health care reform legislation in order to help bring the promise of more freedom to individuals with communication disabilities.”
Rao comes to ASHA’s top elected office with more than 25 years of volunteer experience with ASHA. He has served on a number of ASHA committees and boards, such as the Board of Ethics, the Committee on Honors, and the Special Interest Divisions Board of Division Coordinators. He has also served as president for both the Maryland Speech-Language-Hearing Association and the District of Columbia Association for Healthcare Quality. In 1991, he became an ASHA Fellow, one of the highest honors of the Association. For more information, go to www.asha.org.
[Source: Rehab Management]
We’re looking to place two speech language pathologists in Stockton, California. If you’re interested, please send a resume to email@example.com.
Chart Links, a provider of rehabilitation workflow management software, announces the implementation of its electronic therapy documentation and scheduling by 15 therapists at Tuomey Healthcare System’s Outpatient Rehab Services.
Rehab Services is a leading provider of outpatient physical therapy, occupational therapy, sports medicine, cardiac rehabilitation, developmental pediatrics, audiology and speech therapy in South Carolina. Located in the Tuomey Medical Park, Rehab Services includes physical therapists, occupational therapists, physical therapy assistants, certified athletic trainers, therapy technicians and administrative staff. The facility treats 150-200 patients per day.
“We researched systems for about a year,” says Jerry Shadbolt, M.Ed., ATC and Outpatient Clinical Manager. “We found Chart Links to be the most user-friendly and modifiable to meet our needs. Our goal was to make our clinicians as efficient and productive as possible by ridding ourselves of the paper. Chart Links is a flexible program offering us a variety of documentation templates — from pediatrics to ortho to spine.”
Chart Links software streamlines all of the daily tasks associated with a patient’s physical therapy, occupational therapy, speech language pathology, or audiology visits. The software manages adult and pediatric therapy treatment by automating evaluations, flow sheets, progress notes, patient education, clinical correspondence, and plans of care. It also manages payer compliance, provider reimbursement, outcomes reporting, administrative functions, business intelligence and enterprise productivity.
“From a management perspective,” says Shadbolt, “Chart Links keeps our clinicians compliant and accountable. We now have fewer incomplete documents at the end of the day. And, when it comes to reporting, there will be less of a ‘beastly effort’ to gather data and measure productivity. Overall, I give the product a high grade.”
Affiliated with 301-bed hospital Tuomey Regional Medical Center, Rehab Services has also implemented an interface from MEDITECH, the hospital’s information system, to Chart Links. Components of the interface include registration and billing data.
“Management of authorizations is one area that has greatly improved,” says Renee Brown, Office Manager. “We used to depend on the manual tracking efforts of our therapists and staff. Now, authorizations are automatically tracked in the system.”
About Chart Links, LLC
For over 15 years, Chart Links has developed rehabilitation software that automates workflow for referrals, insurance authorizations, cross-discipline scheduling, documentation, charges, and more. Chart Links allows medical rehabilitation facilities to be more efficient and to provide a higher quality of care by delivering results in the areas of compliance, outcomes, analytics and revenue. For more information about Chart Links, visithttp://www.chartlinks.com
About Tuomey Healthcare System’s Rehab Services
Tuomey’s Rehab Services team works every day to deliver personalized rehabilitation plans to help patients optimize their potential for good health. With an on-site physician, complete range of rehab services, world-class equipment and a team of rehab specialists, the rehab program is recognized as the finest and most comprehensive in the region. Tuomey rehab programs include physical therapy, occupational therapy, sports medicine, cardiac rehabilitation, developmental pediatrics, audiology and speech therapy. For more information, go to http://www.tuomey.com/facilities/tuomeymedicalpark.aspx
The President recently signed “red flags” legislation that makes doctors exempt from the anti-identity theft requirements and safeguards that banks and other creditors must follow.
This amendment to the Fair Credit Reporting Act is primarily a definition of the term “creditor.” Confusion over the definition of “creditor” resulted in a Federal Trade Commission position that physician practices and other small professional service businesses would need to comply with the same regulation that calls for banks and creditors to have written procedures in place to prevent, identify and mitigate identity theft and to train staff to follow those plans. With the new legislation and clarification, compliance is no longer necessary.
In 2010, National Government Services received a request for reconsideration of the Outpatient Physical and Occupational Therapy local coverage determination (LCD) (L26884) to include International Classification of Diseases, Clinical Modification, 9th Revision (ICD-9-CM) codes V57.1-V57.89 as correct coding. Review of the ICD-9-CM manual indicated that the request was technically correct, and therefore the requirement was included in the May 2010 draft revision to the LCD. Numerous comments were received from all National Government Services jurisdictions that such coding was redundant and created additional burden for providers.
The National Government Services medical directors and policy staff agreed with these comments, and sought further guidance from the Centers for Medicare & Medicaid Services (CMS) about whether these diagnosis codes needed to be included in the LCD. CMS has indicated that although the ICD-9-CM manual does include this recommendation, contractors did not have to include these diagnoses in the LCD.
Consequently, the LCD and supplemental instruction article (SIA) are revised, effective November 1, 2010, to delete coding instructions that required ICD-9-CM codes V57.1-V57.89 be included as the primary diagnosis on all therapy claims. Furthermore, National Government Services will not require these diagnosis codes as primary or subsequent codes. National Government Services does, however, note that such a recommendation does exist in the ICD-9-CM manual. If providers use these codes, they must also include the diagnosis code of the specific medical condition for which each therapy service was provided.
To see the document on the NGS website, click on www.NGSMedicare.com, select your Business Type and your Region and click “Go.” On the Provider Specific Portal Home Page, under News and Publications, click on What’s New from the drop down menu.
Source: Gawenda Seminars & Consulting
When documenting physical or occupational therapy visits on paper, much time and labor is spent getting the initial evaluation paperwork to the physicians’ offices. Many therapists rely on dictation, transcription and snail mail to document patient treatment and then communicate with physician offices. As our clients implement Chart Links Rehabilitation Software, we see them eliminating transcription costs by documenting electronically, and, we see them replacing snail mail or printing and faxing with an e-fax solution integrated into the electronic documentation software. These automated processes allow the documentation to get to the physician offices quicker.
One of the biggest benefits immediately realized with electronic therapy documentation is reduced time it takes to document patient treatments. Chart Links customers typically have desktop computers installed within private exam rooms and laptop carts in open gym spaces. Multi-discipline flow sheets easily track patients’ exercises and treatments from visit to visit, making data collection and entry easier than ever. Most therapists complete the treatment notes during the patient visit so that the patient chart is complete soon after the patient leaves the facility.
If you’d like to learn more about Chart Links electronic therapy documentation, visit www.chartlinks.com.
In a recently-published article entitled “Providing a New Connection: Margaret Mary Community Hospital (MMCH) Launches Innovative EMR Solution,” TherapyTimes.com featured the success story of one of Chart Links’ customers from Batesville, IN.
MMCH runs an off-site Outpatient Rehabilitation Center that handles more than 15,000 patient visits annually. The rehab facility employs 21 therapists providing physical, occupational, and speech therapies. The story covers their transition from paper-based to electronic therapy scheduling as well their transition from and existing therapy documentation tool to Chart Links.
MMCH currently uses Chart Links Rehabilitation Software as its end-to-end, niche-specific software solution that ensures documentation accuracy, improves workflow, saves time, streamlines scheduling and generally makes life easier for a totally rehab-focused facility.
With therapists on staff to provide clinical expertise, Chart Links develops, installs, implements and supports a therapy electronic medical record (EMR). We employ a team of software development, implementation and support experts that are with our clients every step of the way.
Our team determines how best to link an electronic patient chart to each critical resource in your outpatient rehabilitation facility. Together, we’ll map out
- How to engineer the system and design the network
- Which systems we’ll need to interface too
- How to prepare your therapists and office staff for implementation
- How to apply technology to your current work flows with the least disruption to staff
- Which reports will help you best manage your facility
If your outpatient rehabilitation facility is currently evaluating electronic therapy documentation systems, please contact Chart Links at www.chartlinks.com
Effective management of any physical therapy, occupational therapy or speech therapy facility requires making informed clinical, financial and administrative decisions everyday.
At Chart Links, we provide an easy-to-use business intelligence and decision support solution that is capable of rendering complex information into a simple-to-understand format.
Visit our website to learn more about analyzing outpatient rehabilitation data.
In their August issue, Physical Therapy Products interviewd physical therapists across the country about the business software they utilize. Chart Links’ user Andrea Marchi, PT, MBA, CSCS from Southeast Missouri Hospital’s HealthPoint Rehab in Cape Girardeau, MO participated in the interviews. Here is what Andrea, the Rehab Manager at this two-location, hospital-based outpatient facility had to say about Chart Links rehabilitation software:
What led you to choose software from this company? Ultimately, we chose ChartLinks for the customization opportunities to best suit our wide range of specialties and disciplines. ChartLinks was able to best fit our needs. [For more information, go to http://www.chartlinks.com/]
What improvements have you seen in daily practice as a result of implementing this software? We have heightened awareness of our trends and reporting for better practice management. Scheduling, especially multidiscipline appointments, is easier and more efficient. Our therapists’ documentation is timelier. [For more information, go to http://www.chartlinks.com/therapy-scheduling.html and/or http://www.chartlinks.com/therapy-documentation.html]
What advice do you have for PTs who are currently in the market for new business software?Choose a system that will be end-user friendly and provides excellent customer support after go-live. [For more information, go to http://www.chartlinks.com/services.html]
What is the best feature of this software? ChartLinks’ has improved our daily efficiency, compliance, and business management. ChartLinks’ Analytics system sets it apart from the competition. With Analytics, we can easily create customizable reports. [For more information, go to http://www.chartlinks.com/analyzedata.html]
What was the implementation process like for this software? Chartlinks’ staff coached us weekly for approximately 8 months. Prior to go-live, we spent two weekends transitioning our documentation/schedule to electronic records followed by transition time for our therapists before returning them to a more typical workload. [For more information, go to http://www.chartlinks.com/services.html]
Are you interested in “diving in” to a comprehensive workflow management system for outpatient therapy management? Contact Chart Links at http://www.chartlinks.com/contact.html
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.”