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 advocacy@apta.org.
I am really curious. How do these risk categories affect a PTPP who is not affiliated with physicians. Our practice totally meets the definition of high risk: A hand practice that is a DME provider. What is the impact of this? Thanks.
Posted by Michael Strakal
on 5/20/2011 3:49 PM
I am curious to scrutinize the data behind the classification for determining "high" "moderate" and "limited" risks? Isnt there a bit of profiling going on here? I understand the classification is somewhat based on the degree of services (and billing) these entities may encompass, but does that render them "high" risk necessarily? All feedback is welcome
Posted by Dave Ravnikar PT, DPT, CSCS
on 5/21/2011 10:45 AM
As expected the government has succeeded in making life more expensive and difficult for the average Joe
How bout allowing the profession the opportunity more leverage in creating our own oversights with less a more
more moderate level of governmental management
Posted by Bruce forsyth
on 5/21/2011 12:16 PM
Hi, my name is Diana Burket and my husband and I run our privately owned PT Clinic. My husband is the PT and I do all the billing/ect. :) My quest. is - we are looking to hire another PT or PTA. Does this mean that Medicare would need to do an onsite visit even though my husband is already a provider with Medicare? I ask this because if we hire a PT - we would want to get them a provider number with Medicare.? Thank you in advance with your feedback.
Posted by Diana Burket
on 5/24/2011 3:39 PM
I enrolled last summer (2010) with Medicare through the PECOS online enrollment. It took until the fall of 2010 to be credentialed and approved. They gave me the wrong NPI number and it took another several months to get it worked out. I was not charged a fee but sure felt like charging CMS one!
Posted by Carol Link
on 5/29/2011 2:45 PM