From the Centers for Medicare and Medicaid Services: The Budget Control Act of 2011 requires, among other things, mandatory across-the-board reductions in Federal spending, also known as sequestration. The American Taxpayer Relief Act of 2012 postponed sequestration for 2 months. As required by law, President Obama issued a sequestration order on March 1, 2013. The Administration continues to urge Congress to take prompt action to address the current budget uncertainty and the economic hardships imposed by sequestration. This message is directed at the Medicare FFS program (i.e., Part A and Part B). In general, Medicare FFS claims with dates-of-service or

Without Congressional intervention by March 1, 2013, sequestration will have across the board budget cuts to every department in the federal government and will have impact on outpatient therapy services. Per the American Physical Therapy Association, sequestration will decrease Medicare payment for outpatient therapy services by

On February 21, 2013, the Centers for Medicare and Medicaid Services (CMS) clarified the manual medical review process for 2013 and the application of the therapy cap as it applies to critical access hospitals. In 2013, Medicare Administrative Contractors (MACs) will conduct

Novitas Solutions, Medicare Administrative Contractor for the states of Arkansas, Colorado, Delaware, Louisiana, Maryland, Mississippi, New Jersey, New Mexico, Oklahoma, Pennsylvania, Texas, and Washington DC, held a teleconference on Physical and Occupational therapy billing for private practices on January 28, 2013 and for non-private practices on January 31, 2013. Novitas Solutions has published the handout on their website for providers to view. To access the handout

From The Center for Medicare Advocacy, Inc. The Center for Medicare Advocacy, along with its co-counsel Vermont Legal Aid are pleased that the Settlement in the Medicare Improvement Standard case, Jimmo v. Sebelius,was approved on January 24, 2013 during a scheduled fairness hearing, marking a critical step forward for thousands of beneficiaries nationwide. The proposed settlement agreement was filed in federal District Court on October 16, 2012. The plaintiffs joined with the named defendant, Secretary of Health and Human Services Kathleen Sebelius, in asking the federal judge to approve the settlement of the case. With only one written comment received,

Effective Jan. 1, 2011, the Centers for Medicare and Medicaid Services (CMS) initiated a new multiple procedure payment reduction policy to reduce the practice expense portion of certain physical, occupational and speech/language therapy procedures by 20 percent in the priavte practice setting, when these procedures are the secondary and/or subsequent procedures reported on a single date of service for the same patient. The policy applies to procedures identified with a Multiple Procedure (MP) indicator 5 on the CMS National Physician Fee Schedule. UnitedHealthcare Medicare Solutions will align with CMS and implement the new Multiple Therapy Reduction Policy, effective with claims

The Office of the Inspector General (OIG) released their fiscal year (FY) 2013 work plan that summarizes new and ongoing reviews and activities that OIG plans to pursue with respect to Health and Human Services programs and operations during the next FY and beyond. Pages of interest to the therapy profession would include pages 8, 20, and 55. To access the work plan, click

The Medicare Payment Advisory Commission (MedPAC) held a 2-day meeting on November 1-2, 2012. In the meeting, one of the topic discussed was improving Medicare’s payment system for outpatient therapy services. To prepare for the presentaiton, MedPAC prepared a brief and preentation for the meeting. MedPAC discussed the number of beneficiaries that received outpatient therapy servcies in 2011, the cost to the Medicare program for those outpatient therapy services, what setting those services occurred in by percentage (i.e. private practice, SNF, rehab agency, outpatient hospital, etc.), where the top 10% and lowest 10% of spedning occurred, and percentage of Medicare