The Centers for Medicare and Medicaid Services (CMS) has finalized their changes to the 2015 PQRS program for physical and occupational therapists in private practice. Besides changes in the number of measures that must be reported, CMS is also implementing the requirement that if a physical or occupational therapist in private practice sees at least one Medicare patient in a face-to-face encounter, that they must report on at least one cross-cutting PQRS measure. The changes to the 2015 PQRS program, in addition to a listing of the new cross-cutting PQRS measures, are summarized below:

The Centers for Medicare and Medicaid Services has published a fact sheet titled “Medicare Enrollment Guidelines for Ordering/Referring Providers” that is designed to provide education on the Medicare enrollment requirements for eligible ordering/referring providers. It includes information on the three basic requirements for ordering and referring and who may order and refer for Medicare Part A Home Health Agency, Part B, and Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) beneficiary services.This is important information for physical therapists, occupational therapists and speech-language pathologists in private practice as well as those who practice in a facility setting such as a hospital

The “Inpatient Rehabilitation Facility Prospective Payment System” Fact Sheet (ICN 006847) was revised and is now available in downloadable format. This fact sheet is designed to provide education on the Inpatient Rehabilitation Facility (IRF) Prospective Payment System (PPS). It includes the following information: background, elements of the IRF PPS, payment updates, and IRF Quality Reporting Program. To access the Fact Sheet, click

The “Skilled Nursing Facility Prospective Payment System” Fact Sheet (ICN 006821) was revised and is now available in downloadable format. This fact sheet is designed to provide education on the Skilled Nursing Facility Prospective Payment System (SNF PPS). It includes the following information: background and elements of the SNF PPS. To access the Fact Sheet, click

The Centers for Medicare and Medicaid Services has published a podcast designed to provide education on the five levels of claim appeals in Original Medicare (Medicare Part A and Part B). It includes details explaining how the Medicare appeals process applies to providers, participating physicians, and participating suppliers in addition to including more information on available appeals-related resources. This would include physical therapists, occupational therapists and speech-language pathologists in private practices as well as those therapists and assistants practicing in facility settings such as hospitals, skilled nursing facilities, home health agencies, rehabilitation agencies, and comprehensive outpatient rehabilitation facilities. The podcast

On February 27, 2014, the Durable Medical Equipment Medicare Administrative Contractors (DME MACs) posted a Coverage Reminder outlining the coding requirements for consideration as a “dedicated” speech generating device under the National Coverage Determination (NCD) for Speech Generating Devices (IOM 100-02 §50.1).  The coverage reminder also referenced a requirement for a written coding verification for speech generating devices that would be effective for dates of service on or after December 1, 2014. CMS has issued instructions to contractors to rescind the coverage reminder and coding verification for speech generating devices. We expect beneficiaries to continue to have access to this

During their November 7, 2014 meeting, the Medicare Payment Advisory Commission (MedPAC) provided a presentation on site-neutral payments for select conditions (17 conditions) treated in inpatient rehabilitation facilities and skilled nursing facilities. The 17 conditions were a mix or orthopedic, pulmonary, cardiac and infections. These conditions accounted for 10% of IRF cases and spending. A previous June 2014 report looked at joint replacement and hip and femur procedures and found that the majority of these patients were treated in the SNF setting. IRF outcomes for these conditions compared with SNF outcomes found:  

In a November 6, 2014 meeting, the Medicare Payment Advisory Commission (MedPAC) reported that observation stays should be eliminated as a way of classifying patients. In recent years, hospitals have increased the number of observation stays due to increased audits by RACs for one-day inpatient admissions. This significant rise in observation stays has had a negative impact on a Medicare beneficiaries ability to have a skilled nursing facility (SNF) admission covered by the Medicare program. In order for a SNF admission to be covered under a beneficiaries Part A benefits, they must have had a qualifying 3-day hospital inpatient admission.