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CMS Publishes 2014 Payment Data

The Centers for Medicare and Medicaid Services (CMS) has prepared a public data set, the Medicare Provider Utilization and Payment Data: Physician and Other Supplier Public Use File (Physician and Other Supplier PUF), with information on services and procedures provided to Medicare beneficiaries by physicians and other healthcare professionals. Other healthcare professionals include physical and occupational therapists as well as speech-language pathologists in private practice.

The Physician and Other Supplier PUF contains information on utilization, payment (allowed amount and Medicare payment), and submitted charges organized by National Provider Identifier (NPI), Healthcare Common Procedure Coding System (HCPCS) code, and place of service. This PUF is based on information from CMS administrative claims data for Medicare beneficiaries enrolled in the fee-for-service program and covers calendar years 2012 – 2014.

If you are a physical therapist, occupational therapist or speech-language pathologist in private practice, you will want to review your data for the past 3 years as this data is all available to the general public. Two important items to track are the units you billed of each CPT code for calendar years 2012 – 2014 as well as the Medicare average payment for each CPT code billed for the 3 years. I will tell you that your average payment for each CPT code paid in 2014 is less than the average payment for the same CPT paid in 2012, but I’m sure your expenses to run the practice went up during the same time period.

To access the data, click

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What is CPT Assistant

CPT Assistant is a monthly publication from the American Medical Association (AMA) that provides information and clarification regarding proper CPT code usage. CPT Assistant can be used for the following:

  • Improve compliance and overturn denials
  • Validate coding to auditors
  • Educate providers, coders, and payers
  • Demystify confusing codes with clinical scenarios
  • Get answers to your most frequently asked questions

For additional information and to subscribe, click HERE.

 

Progress Reports: What are the Required Elements?

In last weeks article, Reevaluations vs Progress Reports: What’s the Difference?, I explained the difference between a reevaluation and a progress report, how the 2 terms are not the same and should not be used interchangeably and when a reevaluation is appropriate to perform and bill to an insurance carrier. This week, I want to discuss what the required elements are for a progress report under Medicare Part B as well as some private/commercial insurance carriers and how often they are required by the Medicare program.

Under Medicare Part B, the Centers for Medicare and Medicaid Services (CMS) states the minimum progress reporting period shall be at least once every

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CMS Releases SNF FY 2017 Proposed Rule

On April 21, 2016, the Centers for Medicare and Medicaid Services (CMS) released the skilled nursing facility (SNF) proposed rule for FY 2017 for services reimbursed under Medicare Part A benefits. Based on the proposed rule, CMS projects payments for SNF’s will increase by 2.1% in FY 2017 compared to FY 2016. The 2017 proposed rule adds to the list of quality measures that will be required of SNFs beginning in 2018 to include data on discharge to community, Medicare spending per beneficiary, and potentially preventable 30-day readmissions. The proposal also stipulates that by 2020, SNFs will be required to supply reports on drug regimen reviews with follow-up.

Public comments on the proposed rule will be accepted until June 20, 2016. To access the proposed rule, click HERE. To access the CMS fact sheet on the FY 2017 SNF proposed rule, click HERE.

CMS Releases IRF FY 2017 Proposed Rule

On April 21, 2016, the Centers for Medicare and Medicaid Services (CMS) released FY 2017 Inpatient Rehabilitation Facility (IRF) proposed rule. In the proposed rule, CMS is proposing to increase IRF payment by 1.45% in FY 2017 compared to FY 2016.

Beginning in FY 2014, any IRF that does not submit the required data to CMS receives a 2.0 percentage point decrease in its annual increase factor for payments under the IRF PPS. The Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act) requires the continued specification of quality measures, as well as resource use and other measures, for the IRF QRP.

In order to satisfy the requirements of the IMPACT Act, CMS is proposing four claims-based measures for inclusion in the IRF QRP for the FY 2020 and FY 2018 payment determination and subsequent years and one new assessment-based quality measure for inclusion in the IRF QRP for FY 2020 and subsequent years, respectively:

Discharge to Community – Post Acute Care (PAC) IRF QRP (claims-based);
Medicare Spending Per Beneficiary (MSPB) – Post-Acute Care (PAC) IRF QRP (claims-based);
Potentially Preventable 30 Day Post-Discharge Readmission Measure for IRFs (claims-based);
Potentially Preventable Within Stay Readmission Measure for IRFs (claims-based); and
Drug Regimen Review Conducted with Follow-Up for Identified Issues (assessment-based).

Pending final data analysis, CMS is also proposing to add four new measures to IRF QRP public reporting on a CMS website, such as Hospital Compare, by Fall 2017.  In addition, we propose to extend the timeline for submission of exception and extension requests for extraordinary circumstances from 30 days to 90 days from the date of the qualifying event.

CMS will accept comments on the proposed rule until June 20, 2016. To access the proposed rule, click HERE. To access the CMS IRF fact sheet on the proposed rule, click HERE.