CMS finalized new cardiac and orthopedic bundled payment models on December 20, 2016, which will reward hospitals who work together with physicians and SNFs to avoid complications, prevent rehospitalizations, and speed recovery. These new payment models intend to improve cardiac and orthopedic care as well as patient outcomes.
Cardiac care payment model: Three new payment models will support clinicians in providing care to patients who receive treatment for heart attacks, heart surgery to bypass blocked coronary arteries, or cardiac rehabilitation following a heart attack or heart surgery.
Orthopedic care payment model: One new payment model will support clinicians in providing care to patients who receive surgery after a hip fracture, other than hip replacement. In addition, CMS is finalizing updates to the Comprehensive Care for Joint Replacement Model, which began in April 2016.
CMS encourages hospitals, physicians, and post-acute care providers to use these new payment models as an educational opportunity to collaborate, share best practices, and improve coordination of care from the initial hospitalization through recovery. These bundles will begin July 2017. Premier Therapy will be providing further education this spring.
The House of Representatives has announced that it has reached a deal on a permanent fix for the Sustainable Growth Rate (SGR)—the flawed Medicare payment formula. Although ASHA staff have not seen the final compromise, it appears that extenders (e.g., therapy caps) were not permanently repealed. Therefore, the therapy cap exceptions process has been given only a 2-year extension without a repeal.
Please call and write your Senators and Representative today through the Capitol Switchboard at 202-224-3121 and take action online to tell them that the Medicare therapy cap must be addressed in the permanent SGR package.
You can also directly tweet your members of Congress!
We also encourage you to call Speaker of the House, John Boehner at 202-225-0600, and Democratic Leader, Nancy Pelosi at 202-225-0100, to express your support for a repeal of the Medicare therapy cap in any SGR reform package.
Take Action Here
The Medicare cap on outpatient rehabilitation therapy services was originally instituted under the Balanced Budget Act of 1997, as a combined cap on speech-language pathology (SLP) and physical therapy (PT) services, as well as a separate cap on occupational therapy (OT) services to Medicare beneficiaries. ASHA, along with other stakeholder groups, have worked tirelessly with both the House and Senate to develop a replacement strategy, which was included in last year’s bicameral, bipartisan agreement.
For more information, please visit our Issue Brief on the Medicare Outpatient Therapy Cap or contact Ingrida Lusis, ASHA’s director of federal and political advocacy, at firstname.lastname@example.org.
Write your Members of Congress Here
FY 2014 SNF PPS MDS 3.0 Policy Changes
Although our website and email addresses have changed…. we continue to be the Premier provider for all your therapy needs and remain committed to making a difference every day!
Visit us at: www.embracepremier.com
Embrace the Difference!
Call for a consultation to see if you are ready for the future at (724) 417- 8840.
As you know, effective July 1, 2013 Functional Reporting applies to all claims furnished under the Medicare Part B outpatient therapy benefit and to Physical Therapy (PT), Occupational Therapy (OT), and Speech- Language Pathology (SLP) services furnished under the Comprehensive Outpatient Rehabilitation Facility (CORF) benefit CMS offers a Quick Reference Guide that summarizes this requirement.
Here is the link to access:
CGS Ask the Contractor (ACT) session- Top Denial Reasons for medical Review January-March 2013.
ACT was held on August 14, 2013. The replay is available until August 20, 2014 by calling 1-888-203-1112, Pass code 8978890. The ACT discussed CGS News article of June 28, 2013 that listed top denials codes, here is the link:
5DOWN – Medical Review Downcode
5D504/5H504 – Information provided does not support the medical necessity for this service
5D501/5H501 – Billed in error 5D507/5H507 – SNF MDS is not in the National Repository
5H508 – Benefits exhausted on SNF claim for services subject to benefit period determination
56900 – Medical records not received 5D171/5H171 – The requirements for a short stay are not met
**** CGS stressed the importance of internal audits as an effective tool to save time and money when dealing with ADRs ****
Call to hear about Premier’s “Audit Score Card” which gives an interdisciplinary documentation report card!
“What information should it contain?”
“How is it different from treatment encounter notes?” For more see:
Medicare FAQ – Questions regarding Therapy Progress Report/Treatment Encounter Notes near top for most frequently asked. Suggests some therapy providers are unsure of the regulation as focus turns on Progress Note reporting for Functional Limitation G codes. Below are links to the questions as well as the LCD for Outpatient Physical and Occupational Therapy.
For information about Premier Therapy’s comprehensive education and audit program to ensure 100% compliance with CMS regulations, please contact Scott Slipko at 724-417-8840.
CMS Frequently Asked Questions
Local Coverage Determination (LCD): Outpatient Physical and Occupational Therapy Services (L31886)