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Congress Overrides Presidential Veto
The United States Senate voted 70-26 and the United States House of Representatives voted 383-41 to override President Bush's veto of HR 6331 - the Medicare Improvements for Patients and Providers Act. This legislation will stop the 10.6% reduction in payment for services reimbursed under the Medicare Physician Fee Schedule and the expiration of therapy cap exception process. HR 6331 becomes law immediately. For further information, visit the APTA website.
CMS Releases Transmittal 88
The Centers for Medicare & Medicaid Services released Transmittal 88 on May 7, 2008. This transmittal includes many important changes and clarifications to outpatient therapy services provided by physical therapists, occupational therapists, and speech-language pathologists. One important item is the official change of the certification time period from 30 calendar days to the duration established in the plan of care and certified by the physician/NPP or 90 calendar days, whichever occurs first. The implementation date of the transmittal is June 9, 2008 with an effective date of January 1, 2008. To view the transmittal, click on the link below.
CMS RELEASES UPDATE ON OUTPATIENT THERAPY CAPS EXCEPTION PROCESS
The Centers for Medicare & Medicaid Services (CMS) issued Transmittal 1414 on January 17, 2008 adjusting the dollar amount for the therapy cap for 2008 along with clarifications to the manual concerning exceptions to outpatient therapy services. This transmittal replaces Transmittal 1407 that was released on January 10, 2008
CMS RELEASES DRAFT FINAL VERSION OF MDS 3.0
The Centers for Medicare & Medicaid Services released the draft final version of MDS 3.0 on January 15, 2008 along with the draft final MDS 3.0 introduction. To view the draft final version as well as additional information on MDS 3.0, please click on the link below.
CONGRESS PASSES THE MEDICARE, MEDICAID AND SCHIP EXTENSION ACT OF 2007
Congress has approved legislation postponing the Medicare therapy cap and scheduled cuts to the physician fee schedule. Lawmakers on Wednesday sent to the president legislation extending the therapy cap exceptions process and implementing a 0.5% positive update in the fee-schedule conversion factor until June 30, 2008. President Bush is expected to sign this legislation into law.
In addition, this legislation permanently freezes the inpatient rehabilitation services compliance threshold at 60%, effective for cost reporting periods starting July 1, 2006, and allows comorbid conditions to count toward this threshold. Sets the market basket update factor at 0% from April 1, 2008 through FY09. Requires the Secretary to study beneficiary access to inpatient rehabilitation services and care at IRFs and to make recommendations for classifying inpatient rehabilitation facility hospitals and units.
CMS Releases 2008 Medicare Physicain Fee Schedule Final Rule
The Centers for Medicare & Medicaid Services (CMS) releaed the final rule for services reimbursed under the Medicare Physician Fee Schedule on November 1, 2007 and it was published in the Federal Register on November 27, 2007. Highlights for therapy include changing the outpatient recertification requirement from once every 30 days to once every 90 days in all settings, including CORF's. This becomes effective January 1, 2008. In addition, CMS will provide manual clarification in mid-2008 regarding the implementation of applicable outpatient policies to the inpatient hospital setting. CMS will also implement the qualification standards of who can provide and be reimbursed for skilled therapy services from the outpatient setting to all settings. The standards will be phased in over a 2 year period. Pages of interest include 73-83 regarding CORF issues, 108-113 regarding qualification standards, students, and recertifications, and a summary from pages 177-188. To view the final rule, please click on the link below.
National Government Services Releases IRF LCD
National Government Services (NGS), Medicare Contractor for the states of IN, IL, KY, ME, MA, NH, VT, CT, DE, NY, OH, WI, MI, VA, WV, AS, CA, CNMI, GU, HI, and NV, has released the IRF LCD on October 1, 2007 for the Notice Period with an effective date of the LCD of December 1, 2007. In addition, NGS released the comments they received regarding the LCD and their response. For more information, please click on the appropriate link below.
NGS IRF LCD Comments & Responses
CMS Releases Fiscal Year 2008 IRF Final Rule
The Centers for Medicare & Medicaid Services released the fiscal year 2008 IRF final rule in the Federal Register on August 7, 2007. The effective date is October 1, 2007. There are no changes to the 75% rule in terms of diagnoses that count towards the 75% rule and co-morbidities will no longer count towards the 75% rule beginning with cost reporting periods on and after July 1, 2008. To read the entire final rule, click on the link below.
IRF Fiscal Year 2008 Final Rule
CMS Releases Transmittal Regarding Charging for Missed Appointments
The Centers for Medicare & Medicaid Services released Transmittal 1279 on June 29, 2007 clarifying that they do not prohibit physicians, suppliers, and hospitals for charging Medicare patient's for missed appointments as long as they do not discriminate against Medicare beneficiaries and also charge non-Medicare patient's for missed appointments. Effective date is October 1, 2007.
CMS Releases Transmittal Clarifying Therapy Evaluations in SNF Setting
The Centers for Medicare & Medicaid Services released Transmittal 73 on JUne 29, 2007 clarifying that a PT, OT, and/or SLP evaluaiton must be performed during the beneficiary's stay in the SNF setting. It is not acceptable to use an evaluation that was performed, for instance, in the acute care hosiptal or IRF setting because the beneficiary's status must be evaluated in the SNF setting. To view the transmittal, click on the link below.
Therapy Evaluations in SNF Setting
CMS rescinds Transmittal 65
The Centers for Medicare & Medicaid Services has rescinded Transmittal 65 concerning the application of the outpatient documentation requirements to the inpatient setting and defining who are qualified professionals to provide and bill for therapy services. Please click on the link below to see that Transmittal 65 has been rescinded. Future information will be posted when it becomes available.
CMS Issues Infrared Decision Memo
CMS released Transmittal 1127 and Transmittal 62 on December 15, 2006 providing further information on Infrared devices that supplements the national coverage decision that went into effect on October 24, 2006. Transmittal 1127 was rescinded and replaced by Transmittal 1183 on February 9, 2007. This new Transmittal provides ICD-9 codes that do not support the medical necessity of infrared devices. The transmittal may be accessed by clicking on the below links.
The CMS issued a decision memo regarding infrared devices on October 24, 2006. CMS has determined that there is sufficient evidence to conclude that the use of infrared devices is not reasonable and necessary for treatment of Medicare beneficiaries for diabetic and non-diabetic peripheral sensory neuropathy, wounds and ulcers, and similar related conditions, including symptoms such as pain arising from these conditions. Therefore, we are issuing the following National Coverage Determination.
The use of infrared and/or near-infrared light and/or heat, including monochromatic infrared energy (MIRE), is not covered for the treatment, including symptoms such as pain arising from these conditions, of diabetic and/or non-diabetic peripheral sensory neuropathy, wounds and/or ulcers of skin and/or subcutaneous tissues in Medicare beneficiaries.
To read the entire CMS decision memo, click on the link below.
CMS issues UB-04 Claim Form Instructions
The Centers for Medicare & Medicaid Services issued Transmittal 1018 on July 28, 2006 that contains instructions for the completion of the UB-04 claim form. This transmittal was rescinded and replaced with Transmittal 1104 that was released on November 3, 2006. The UB-04 claim form will be used by all providers of therapy services who are not a private practice and will replace the UB-92 claim form that is currently being used by institutional providers. The UB-04 can be used by providers beginning on March 1, 2007, but will not be mandated for use until May 23, 2007. To learn more about the UB-04 claim form, click on the link below.
Instructions for the Completion of the UB-04 Claim Form
CMS issues Revised 1500 Claim Form Instructions
The Centers for Medicare & Medicaid Services issued Transmittal 1058 on September 15, 2006 that contained revised instructions for the completion of the new 1500 claim form that can begin to be used on January 1, 2007, but will not be mandated for use until April 2, 2007. Transmittal 1058 replaces previous transmittals that contained information and instructions regarding the new Form CMS-1500 (08/05)
CMS Releases Information On Therapy Cap Exception Process
The Centers for Medicare & Medicaid Services released 3 transmittals on February 13, 2006 outlining the therapy cap exception process. The first transmittal contains information that will be included in the Medicare Benefit Policy Manual, Chapter 15. The second transmittal contains information that will be included in the Medicare Program Integrity Manual, Chapter 3. The third transmittal contains information that will be included in the Medicare Claims Processing Manual, Chapter 5. The exception process must be implemented no later than March 13, 2006. To access the transmittals, please click on the links below:
Transmittal 47: Medicare Benefit Policy Manual
Transmittal 140: Medicare Program Integrity Manual
Transmittal 855: Medicare Claims Processing Manual
Therapy Cap Exception Process Fact Sheet
CCI Edits To Apply To Rehab Agencies, SNF Part B, CORF's, and HHA's
Effective January 1, 2006, the Medicare CCI edits will be applied to Rehab Agencies, Skilled Nursing Facilities (SNF) providing outpatient therapy under Medicare Part B, Comprehensive Outpatient Rehabilitation Facilities (CORF), and Home Health Agencies (HHA) providing home health services not under a home health plan of treatment. Currently, the CCI edits are only being applied to rehabilitation therapy services provided by physical and occupational therapists in private practice, physician owned physical and occupational therapy practices, and in hospital outpatient departments. This is not applicable to Critical Access Hospitals. For further information on this very important topic, please click on the Medlearn Matter link below.