On July 31, 2014, the Department of Health and Human Services issued a rule finalizing October 1, 2015 as the new compliance date for health care providers, health plans, and health care clearinghouses to transition to ICD-10. The rule was published in the Federal Register on August 4, 2014.

On August 6, 2014, the Centers for Medicare and Medicaid Services (CMS) issued Medicare Program; Inpatient Rehabilitation Facility Prospective Payment System for Federal Fiscal Year 2015; Final Rule. Inpatient Rehabilitation Facilities (IRFs) will receive a 2.2% increase in their FY 2015 payments compared to FY 2014. The final rule discusses revisions to the 60 Percent Rule Presumptive Compliance Criteria, definitions of individual therapy, group therapy, co-treatment therapy and concurrent therapy, and revision to the IRF-PAI for arthritis conditions. Revisions to the 60 Percent Rule Presumptive Compliance Criteria CMS finalizes its proposal to remove 10 status post-amputation diagnoses codes from the

On August 5, 2014, the Centers for Medicare and Medicaid Services (CMS) issued Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities for FY 2015; Final Rule. Payments to skilled nursing facilities (SNFs) will increase by 2% in FY 2015. This translates to an estimated additional $750 million compared to FY 2014. SNF Therapy Research Project CMS contracted with Acumen, LLC and the Brookings Institution to identify potential alternatives to the existing methodology used to pay for therapy services received under the SNF PPS. Under the current payment model, the therapy payment rate component of the SNF

On August 4, 2014, the Centers for Medicare and Medicaid Services (CMS) announced that due to the continued delay in awarding new Recovery Auditor contracts, the CMS is initiating contract modifications to the current Recovery Auditor contracts to allow the Recovery Auditors to restart some reviews. Most reviews will be done on an automated basis, but a limited number will be complex reviews of topics selected by CMS. Work continues on the procurement process for the four Part A / Part B Regions and the national DMEPOS/HH&H Region. The CMS remains hopeful that the new round of Recovery Auditor contracts

The CERT A/B MAC Outreach & Education Task Force, a partnership of all A/B Medicare Administrative Contractors, has created a guide to educate providers on common documentation errors for outpatient rehabilitation therapy services. These widespread errors contribute to Medicare’s national payment error rate, as measured by the Comprehensive Error Rate Testing (CERT) program. The guide also discusses contents for a plan of care, signature and certification of the plan of care, treatment note, and functional reporting requirements. The leading cause of payment errors for therapy services is

The Centers for Medicare and Medicaid Services (CMS) has issued an educational resource detailing signature requirements for physicians, non-physician practitioners, providers, suppliers, and other health care professionals who order or provide Medicare-covered services to Medicare beneficiaries. The Medicare program accepts the following types of signatures: handwritten, electronic, and under certain circumstances, rubber stamped signatures are acceptable. For the complete details on signature requirements for diagnostic tests, DME supplies, Certificates of Medical Necessity, signature guidelines for medical review purposes, and use of rubber stamp for signature, click

The Centers for Medicare and Medicaid Services has released the calendar year (CY) 2015 proposed rule for services reimbursed under the Medicare Physician Fee Schedule that does include outpatient therapy services. Highlights of the proposed rule as they pertain to outpatient rehabilitation therapy are as follows:    

Effective July 1, 2014, physical therapists, occupational therapists, and speech-language pathologists in private practice will begin receiving updated Remittance Advice Remark Codes (RARCs) on their explanation of benefits (EOB’s) for PQRS claims-based reporting that went into effect on April 1, 2014. The new RARCs are as follows: