Beginning June 1, 2013, Aetna will no longer reimburse separately for

On March 15, the Medicare Payment Advisory Commission (MedPAC) issued its annual report to Congress. Chapters of interest include the following: Chapter 4: Physician and other health professionals Chapter 8: Skilled nursing facility services Chapter 9: Home health services Chapter 10: Inpatient rehabilitation facility services At the end of each Chapter, MedPAC provides recommendations how Medicare payments should change in 2014 in each one of the settings listed above.

Senate Bill 277 was signed into law by Gov Mike Beebe on March 14, 2013. As a result, patients now will pay less out of their own pockets when they visit a PT, OT, and/or SLP, resulting in improved access to vital health care. SB 277 specifies that patient copays, coinsurance, and office visit deductibles charged by health benefit plans for services provided by physical therapists, occupational therapists, and speech language pathologists may not be higher than those charged for services provided by primary care physicians. SB 277 will take effect 90 days after the legislature adjourns.

Priority Health, who is a managed care organization in Michigan, has sent new contracts to private practices in Michigan that will change Priority Healths payment for their HMO and PPO products. Contracts are due back to Priority Health by May 1, 2013. The new contract will change reimbursement from a

On April 24, 2013, Rep Michael Burgess (R-TX) introduced the Rehabilitative Therapy Parity for Military Beneficiaries Act (HR 1705). The pertinent part of the law reads as follows: “(g) Rehabilitative therapy provided pursuant to subsection (a)(17) may include additional therapeutic exercises or therapeutic activities if such exercises or activities are included in the authorized individual plan of care of the individual receiving such therapy. Such exercises or activities may include, in addition to other therapeutic exercises or therapeutic activities, therapies provided on a horse, balance board, ball, bolster, and bench”. “Every patient is different, has a different set of needs,

Pulmonary rehabilitation may be covered under Medicare Part B (“Part B of A”) for dates of service on or after January 1, 2010. Coverage was established in Section 144(fff)(1)) of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA), and CMS declined to establish a National Coverage Determination (NCD) for pulmonary rehabilitation services. The Centers for Medicare & Medicare Services (CMS) published MLN Matters article MM6823, “Pulmonary Rehabilitation (PR) Services,” which further describes the guidelines associated with coverage of pulmonary rehabilitation under Medicare. Cahaba Government Services has published an article to provide the criteria for coverage and the

The Centers for Medicare and Medicaid Services (CMS) has released frequently asked questions (FAQs) regarding the outpatient therapy manual medical review process. The most recent FAQs are updated as of April 17, 2013 and answer questions concerning the involvement of the recovery auditors in the manual medical review process. To access the document, click

Recovery Auditor, Connolly, will be conducting prepayment and postpayment reviews on outpatient therapy claims that have exceeded the $1900 therapy cap for PT/SLP combined and $1900 for OT. In addition, Connolly, will be conducting prepayment and postpayment reviews on outpatient therapy claims that have exceeded the $3700 threshold for PT/SLP combined and $3700 for OT. These reviews will impact