APTA recently met with officials from the Centers for Medicare and Medicaid Services' (CMS) Center for Program Integrity to discuss several concerns related to new enrollment policies outlined in a rule issued in February aimed at curbing fraud and abuse under Medicare, Medicaid, and the Children's Health Insurance Program.
One area of concern is the placement of physical therapists in private practice (PTPPs) in the "moderate risk" category rather than the "limited risk" category, which includes physicians and other therapists. APTA explained that the reports the Office of Inspector General used for the basis of the decision were not focused specifically on private practice settings, but rather on all outpatient therapy settings. APTA requested that CMS amend the rule to classify PTPPs in the "limited risk" category instead of the "moderate risk" category. The discussion also addressed the "high risk" classification assigned to PTs and physicians who also enroll as durable medical equipment and orthotics (DMEPOS) suppliers, such as hand therapists. APTA requested that CMS change the rule so that physicians, PTPPs, and other professionals who also enroll as DMEPOS suppliers to provide items as an integral part of their plan of care, be placed in the "limited risk" category when enrolling (or re-enrolling) as a DMEPOS supplier. However, changes to these classifications would require rulemaking.
The association also raised concerns with potential delays in enrollment that could result from the onsite visit that is required prior to enrollment for private practice office settings. In addition, APTA advised the officials that some PTs have reported that they have been charged a $505 enrollment fee. The agency confirmed that PTPPs should not be charged this fee. CMS stated that it will refund the fees collected and further educate Medicare Administrative Contractors about this topic.
If you are experiencing delays in enrollment due to site visits or contractors are requesting $505.00 enrollment fees, contact APTA at firstname.lastname@example.org.
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