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

For the past several years, the American Physical Therapy Association (APTA) has been working on the development of an alternative payment system (APS) for Medicare beneficiaries receiving outpatient physical therapy services. The APS is now known as the physical therapy classification and payment system (PTCPS). The Senior Director of Payment and Practice Management at the APTA, Carmen Elliott, MS, recently joined PT Talker to share details about PTCPS. Click HERE to hear the full podcast to learn how PTCPS will impact your practice

From the Wall Street Journal, a state-by-state comparison on healthcare costs for calendar year 2009. Click HERE for the story.

Beginning April 15, 2013, the additional documentation requests (ADRs) limits that can be requested by recovery auditors has been reduced to a minimum request of 20 records in a 45-day period from hospital and other provider campuses, instead of the previous minimum of 35 records. In addition, only 75% of a hospital’s record request limit may be used for a particular type of claim, such as inpatient, down from 100% previously. Click HERE to access the CMS document.

The Centers for Medicare and Medicaid Services issued a fact sheet outlining the settlement in Jimmo v. Sebelius, including their next steps. To access the fact sheet, click HERE.

The Centers for Medicare and Medicaid Services (CMS) has updated their survey and certification guidelines for outpatient rehabilitation facilities (i.e. Rehab Agencies). CMS released transmittal