Source: APTA.org

ALEXANDRIA, VA, September 4, 2008 — Physical therapists and other health care professionals that provide durable medical equipment and prosthetic and orthotic services to Medicare beneficiaries will be exempt from the program’s accreditation process and quality standard requirements, the Centers for Medicare and Medicaid Services (CMS) announced Wednesday.

“This is a huge victory for patients and health care professionals across this nation,” American Physical Therapy Association (APTA) President R Scott Ward, PT, PhD, said. “Physical therapists already provide care of the highest quality, so these unnecessary requirements would have been overly burdensome, costly and could have created obstacles for patients needing these services.”

As originally proposed, physical therapists and other health care providers would have been required to meet certain quality standards and be accredited by an independent accreditation organization in order to bill for these services. The deadline for new suppliers was March 2008, while the deadline for existing suppliers was September 2009.

APTA worked with the American Medical Association, the American Academy of Orthopaedic Surgeons, the American Academy of Ophthalmology, the American Podiatric Medical Association, the Medical Group Management Association, the American Occupational Therapy Association, and the American Optometric Association to convince CSM to eliminate the accreditation process.

Physical therapists are health care professionals who diagnose and manage individuals of all ages, from newborns to elders, who have medical problems or other health-related conditions that limit their abilities to move and perform functional activities in their daily lives. Physical therapists examine each individual and develop a plan of care using treatment techniques to promote the ability to move, reduce pain, restore function, and prevent disability. Physical therapists also work with individuals to prevent the loss of mobility by developing fitness- and wellness-oriented programs for healthier and more active lifestyles.

APTA (www.apta.org) is a national organization representing physical therapists, physical therapist assistants, and students nationwide. Its goal is to foster advancements in physical therapist education, practice, and research. Consumers can visit www.findapt.us to find a physical therapist in their area, as well as www.apta.org/consumer for physical therapy news and information.

Source: APTA.org

Responding to pressure from APTA and a coalition of health care organizations, the Centers for Medicare & Medicaid Services (CMS) agreed to exempt physical therapists and other health care providers from the accreditation process and quality standard requirements to provide durable medical equipment and prosthetic and orthotic services (DMEPOS) to Medicare beneficiaries. Complying with the requirements would have been burdensome and costly for physical therapist practices, which are recognized as providing high-quality services and were not the primary target of the process. APTA worked closely with the American Medical Association, the American Association of Orthopaedic Surgeons, the American Occupational Therapy Association, and other provider groups to convince the agency to grant the exemption.

Source: APTA.org

APTA has urged the Centers for Medicare & Medicaid Services (CMS) to delay implementation of the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) until at least 2013 — 2 years later than the agency proposed in August.

The proposed rule from the US Department of Health & Human Services (HHS) would require health care providers and clinical laboratories to use the new ICD-10 code sets as the standard for coding diagnoses on all HIPAA standard transactions. Requiring providers to adopt the ICD-10 code sets by 2011 would “dramatically increase costs for practices,” according to a new cost study initiated by a broad group of provider organizations, including APTA. For a three-provider practice, the total cost to implement ICD-10 is estimated to be $83,290. For a medium-sized practice (about 10 providers), costs could exceed $285,000.
Developed almost 30 years ago, ICD-9 contains 17,000 codes, and is expected to start running out of available codes next year. The ICD-10 code sets contain more than 155,000 codes.

HHS also proposed adopting the new HIPAA transaction standard (Version 5010) by April 1, 2010. According to HHS, the updated standards are more specific in requiring the data that are needed, collected, and transmitted in a transaction. Version 5010 must be implemented before transitioning to the ICD-10 code sets.

In comments to the agency that echo concerns raised in a recent study, the Association said that significantly more time is necessary for physical therapists and other providers to adopt the new standards, which include a much larger and more detailed set of codes that the ICD-9 code set currently in use. APTA also joined a broad coalition of health care provider organizations in a statement urging the agency to provide more time for practices to adopt the new codes. CMS also released a fact sheet on the expanded code set.

Source: APTA.org

Physical therapists should be aware of a new aggressive campaign to prevent fraud, waste, and abuse in the Medicare system. The Centers for Medicare & Medicaid Services (CMS) is expanding the controversial recovery audit contractor (RAC) program nationally to identify overpayment and underpayments from Part A and Part B Medicare providers. RACs are paid on a contingency fee basis, receiving a percentage of the overpayments and underpayments they collect from providers.

The RACs use automated software programs to identify potential payment errors, such as duplicate payments, lack of medical necessity, and incorrect coding. The agency reported that a 3-year demonstration program in six states recovered more than $900 million in overpayments to health care providers.

CMS plans to have four RACs in place by 2010 that will be responsible for all 50 states. The RAC program was scheduled for implementation in nineteen states beginning October 2008 but has been temporarily postponed due to a protest by two unsuccessful bidders for the RAC program. The protest is expected to be resolved in early February. The four RAC contracts and any work under those contracts are on hold pending the outcomes of the protests.

Information on the RAC program is available at CMS’s website http://www.cms.hhs.gov/rac/

Source: APTA.org

Regulations issued November 7 by the Centers for Medicare & Medicaid Services (CMS) may interfere with the delivery of Medicaid hospital outpatient therapy services in states that have established a separate benefit for physical therapy services in their state Medicaid plan. The final rule states that, effective December 8, physical therapy services will continue to be covered as part of the Medicaid outpatient hospital benefit in states that do not have a separate benefit for those services. However, in states that have established a separate outpatient PT benefit, CMS mandates that the state pay for PT services delivered in the outpatient hospital setting using the payment methodology defined in the separate benefit under the state Medicaid plan.

APTA will closely monitor state-by-state implementation of the rule to assess the full impact on each state Medicaid program and address any coverage issues that may arise. A summary of the rule is available to APTA members.

Source: APTA.org

The recent arrest of a licensed Mississippi physician, who owned a clinic that allegedly fraudulently billed Medicare for $16 million for physical therapy services, serves to remind APTA members that it is it is inappropriate for unqualified individuals to provide physical therapy services. APTA’s positions on supervision and direction of personnel state that physical therapists are the only professionals who provide physical therapy interventions, and physical therapist assistants, under the supervision of a physical therapist, provide selected physical therapy interventions.

This case is part of a larger physical therapy fraud initiative between the US Attorney’s Office for the Southern District of Mississippi and US Department of Health and Human Services Office of Inspector General. Most of the cases involve the provision of services by unqualified personnel and physicians who were not supervising billing practices

Source:  CMS.HHS.GOV

The Centers for Medicare & Medicaid Services (CMS) has expanded its Internet-based Provider Enrollment, Chain and Ownership System (PECOS) — allowing physical therapists in 34 states and the District of Columbia to enroll, make a change in their Medicare enrollment information, or track the status of their Medicare enrollment applications via the Internet-based system. When a provider submits the initial Medicare enrollment application through PECOS, an application can be processed as much as 50% faster than by paper, says CMS.  

PECOS will be implemented for physicians and non-physician practitioners, including physical therapists, in all states within the next 2 months. The system will be available next year to all providers and suppliers (except suppliers of durable medical equipment, prosthetics, and orthotics). Go to CMS’ Web site to determine if your state, provider, or supplier type is eligible for this new, stream-lined enrollment process.

Source: American College of Rheumatology (ACR)

Tai chi is effective in the treatment of pain and physical impairment in people with severe knee osteoarthritis, according to research presented at the American College of Rheumatology Annual Scientific Meeting in San Francisco, California.

The ACR is an organization of and for physicians, health professionals, and scientists that advances rheumatology through programs of education, research, advocacy and practice support that foster excellence in the care of people with or at risk for arthritis and rheumatic and musculoskeletal diseases. For more information on the ACR’s annual meeting, see www.rheumatology.org/annual.

Source: American Academy of Orthopaedic Manual Physical Therapists

Physical therapists from around the world converged on Seattle for the annual conference of the American Academy of Orthopaedic Manual Physical Therapists (AAOMPT). Pain: From Science to Solutions, the conference theme, speaks to the unique role physical therapists have in combating pain. Pain from musculoskeletal problems such as back and neck pain is a leading cause of healthcare utilization.

AAOMPT president, Tim Flynn, PT, PhD, said about the conference, “This is an exciting time for physical therapy and for healthcare. On one side, we have a tremendous amount of research emerging in support of manual physical therapy for pain relief, and on the other side we see the stars aligning for great change in the healthcare industry.” Flynn continued, “As a patient, your choices come down to drugs, surgery, or physical therapists. Physical therapists can offer a low-cost solution for patients with pain and high-quality research supports what we do.”