New cardiac and orthopedic bundled payment models to join existing CJR Model

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.

We need your help: Medicare Therapy Cap

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ASHA staff have not seen the final compromise, it appears that extenders (e.g., therapy caps) were not permanently repealed.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 .

Write your Members of Congress Here

Affordable Care Act Update

 Another Premier Update…

Affordable Care Act Update Released 2/10/14

Congress released an announcement regarding mandatory employer compliance with the Affordable Care Act (Obama Care).

*  Employers with 50-100 full time employees(>30 hours per week)

the announcement changed the mandate date to January 2016 from 2015 for compliance.
*  Employers with more than 100 full time employees-the announcement did not change the compliance date, it remains January 2015.  But, mandatory compliance standards have been eased, covered employee levels have decreased from 95% to 75% of full time employees.

Medicaid  eligible employees that enroll in Medicaid coverage count toward the above mentioned mandatory employer compliance percentage levels.

Also Congressional agreement is nearing for “doc fix”.  Preliminary talk include increasing doctor rates .5% per year for the next five years.  Work still remains on exactly how Congress will pay for this rate increase.  The “doc fix” is expected to be tied to Therapy Med B caps either changing or continuing.

To hear more regarding The Affordable Care Act changes contact me, Scott Slipko: 724.417.8840

or email me

Premier Therapy


Premier Therapy
701 Sharon Road
Beaver Pennsylvania 15009
United States


Protecting Access to Medicare Act of 2014

On April 1, 2014, President Obama
signed into law the
Protecting Access to Medicare Act of 2014

  • 12-month SGR Patch


  • .5% provider payment update through end of year


  • Extension of therapy cap exceptions process 


  • Delay of ICD-10    


Call to hear how Premier Therapy
will keep 
your facility up-to-date
with all changes.

Scott Slipko
Business Development Manager


CMS Released Therapy G-codes Quick Reference Guide

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!

Therapy Progress Report Questions Continue…

“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)