On July 1, 2013, the Centers for Medicare and Medicaid Services (CMS) issued a revised MLN Matters publication on expedited determinations for provider service terminations. This MLN Matters® Article is intended for Home Health Agencies (HHAs), Comprehensive Outpatient Rehabilitation Facilities (CORFs), Hospices, and Skilled Nursing Facilities (SNFs) providing services to Medicare beneficiaries. This has implications for therapy services reimbursed under both Part A and Part B benefits. Topics discussed include: Health Care Settings in Which the Expedited Determination Process is Available to Beneficiaries, Care Settings in which Notice of Medicare Non-Coverage (NOMNC) Delivery Does Not Apply, NOMNC Preparation and Delivery, Amending

On August 1, 2013, Congresswoman Jackie Speier (D-San Francisco/San Mateo), along with Rep. Jim McDermott (D-WA), Ways and Means Health Subcommittee Ranking Member, and Dina Titus (D-NV), introduced HR 2914, the “Promoting Integrity in Medicare Act of 2013” (PIMA) in the House of Representatives. The bill would cut unnecessary Medicare spending by hundreds of millions annually without reducing the essential care that seniors rely on. The bill has the support of the Alliance for Integrity in Medicare (AIM), a broad coalition of medical societies committed to ending the practice of inappropriate physician self-referral and focused on improving patient care and

On July 10, 2013, the United States Government Accountability Office (GAO) released a report on the implementation of the 2012 manual medical review process for outpatient therapy services. Excerpts from the report can be found below. The Centers for Medicare & Medicaid Services (CMS) implemented two types of manual medical reviews (MMR)–reviews of preapproval requests and reviews of claims submitted without preapproval–for all outpatient therapy services that were above a $3,700 per-beneficiary threshold provided during the last 3 months of 2012. CMS officials estimated that the MACs reviewed an estimated total of 167,000 preapproval requests and claims for outpatient therapy