The Centers for Medicare and
Medicaid Services (CMS) recently reported that
physical therapists and other providers who bill Medicare for outpatient
therapy services may have recently noticed an increase in the frequency of
Health Insurance Portability and Accountability Act rejection codes on their
provider notification letters. Medicare routinely mails these letters to
providers when various identified claims cannot be successfully crossed over to
their patient’s supplemental insurance companies.
The codes are:
you see "_____" directly above, the value [for example, G8978;
modifier CH; or CARC 246] was reported, when applicable, on the outbound
provider notification letter that billing offices would have received.)
CMS states that the new functional
G-codes, new severity/complexity modifiers, and new Claim Adjustment Reason
Code (CARC) 246 for the January 2013 Healthcare Common Procedure Coding System
(HCPCS) and CARC updates were inadvertently not loaded. As a result, a
moderate number of Part B outpatient therapy claims (claims for physical
therapy, speech-language pathology services, and occupational therapy) were
rejected in error. The newly added severity/complexity modifiers were as
follows: CH, CI, CJ, CK, CL, CM, and CN. The new functional G-codes
fall within the following ranges:
To remedy this issue, the
Coordination of Benefits Contractor (COBC) HIPAA validation vendor added the
new G-codes to its HCPCS table as of January 28. The vendor then added the
new severity/complexity modifiers to its HCPCS table as of February
11. Lastly, the vendor added the new CARC 246 to its table as of February
25. Thus, Medicare participating therapists, physicians, and nonphysician
providers should now see a drastic
decrease in the incidence of error codes H51000, H51061-H51064, and
H51108 reflected on their provider notification letters.
If your billing office received a
provider notification letter from Medicare indicating that claims could notbe crossed over due to one of the H-series error messages described
above, there unfortunately is not
a way for Medicare to retransmit the affected claims to your patients’
supplemental insurers. Therefore, you will need to bill your patients'
supplemental insurers directly.
To help mitigate this kind of problem
in the future, CMS will implement a fail-safe strategy in advance of the
scheduled installation of new HCPCS or other code updates. This will
ensure that any incorrectly rejected Medicare crossover claims will be repaired
by all A/B Medicare Administrative Contractors, thus minimizing the impact to
the provider community.
notice, titled CMS Reports Problem Impacting Crossover of Medicare Part B
Outpatient Therapy Claims, can be found in the March 7 issue of Provider e-News.
has added a new resource to its Balance and Falls webpage to help
physical therapists reduce falls that occur
during a patient's hospital stay. "Preventing Falls in Hospitals: A
Toolkit for Improving Quality of Care" addresses hospital readiness,
program management, fall prevention practices, implementation, measurement, and
sustainability. Developed by the Agency for Healthcare Research and Quality,
the toolkit is designed for
multiple uses. The core document is an implementation guide organized under 6 major
questions intended to be used primarily by the implementation team charged with
leading the effort to put the new prevention strategies into practice. The
full guide also includes links to tools
and resources found in the Tools and Resources section of the toolkit,
on the Web, or in the literature. The tools and resources are designed to be
used by different audiences and for different purposes, as indicated in the
On Friday, the Department of Health
and Human Services (HHS) released a new report identifying interventions that can help increase physical activity
in youth aged 3-17 years across a variety of settings. The primary audiences
for the report are policymakers, health care providers, and public health
professionals. APTA submitted comments in December 2012 on the draft report.
Physical Activity Guidelines for
Americans Midcourse Report: Strategies to Increase Physical Activity Among
Youth summarizes intervention strategies based on the evidence from
literature reviews and is organized into 5 settings where youth live, learn,
and play: school, preschool and childcare, community, family and home, and
primary health care.
Key findings of the report suggest that:
Other materials released by HHS include an infographic
highlighting opportunities to increase physical activity throughout the day and
a youth fact sheet summarizing the report's
recommendations for youth aged 6-17 years. More information can be found at www.health.gov/paguidelines/midcourse/.
APTA has long supported HHS' efforts to increase awareness about the
benefits of physical activity. It provided input on the 2008
Physical Activity Guidelines for Americansrelated to the importance of considering physical activity needs
and barriers for people with disabilities. It also served on the Physical
Activity Guidelines Reaction Group. The association also contributes to the Be Active Your Way Blog.
therapists (PTs) and physical therapist assistants (PTAs), especially those who
have patients with wounds, are encouraged to take steps to protect their most
vulnerable patients from carbapenem-resistant Enterobacteriaceae (CRE), a
family of germs that have become difficult to treat because they have high
levels of resistance to antibiotics. In addition to patients at high risks, PTs
and PTAs should take all necessary precautions to prevent the spread of CRE to
According to the Centers for Disease Control and Prevention
(CDC), CRE are resistant to all, or nearly all, antibiotics—even the most
powerful drugs of last-resort. CRE also have high mortality rates, killing 1 in
2 patients who get bloodstream infections from them. Additionally, CRE easily
transfer their antibiotic resistance to other bacteria. For example,
carbapenem-resistant klebsiella can spread its drug-destroying properties to a
normal E. coli bacteria, which makes the E.coli resistant to
antibiotics also. "That could create a nightmare scenario since E. coli
is the most common cause of urinary tract infections in healthy people,"
CRE are usually transmitted
person-to-person, often on the hands of health care workers. Currently,
almost all CRE infections occur in people receiving significant medical
care. However, their ability to spread and their resistance raises the
concern that potentially untreatable infections could appear in otherwise
healthy people, including health care providers.
includes resources for patients, providers, and
facilities. The agency's CRE prevention toolkit has in-depth recommendations to
control CRE transmission in hospitals, long-term acute care facilities, and
is in the process of updating its Infectious Disease Control webpage to ensure that
PTs and PTAs have the information they need to understand their critical role
in helping to halt the spread of CRE. Look for a follow-up article in News
Now when the webpage is launched.
has selected 9 association members to serve on the PTA Education Feasibility
Study Work Group: Wendy Bircher, PT, EdD (NM), Derek Brandes (WA), Barbara
Carter, PTA (WI), Martha Hinman, PT, EdD (TX), Mary Lou Romanello, PT, PhD, ATC
(MD), Steven Skinner, PT, EdD (NY), Lisa Stejskal, PTA, MAEd (IL), Jennifer
Whitney, PT, DPT, KEMG (CA), and Geneva Johnson, PT, PhD, FAPTA (LA). The work group is addressing the motion Feasibility Study
for Transitioning to an Entry-Level Baccalaureate Physical Therapist Assistant
Degree (RC 20-12) from the 2012 House of Delegates. The work group will address
the first phase of the study, finalizing the study plan and identifying
relevant data sources for exploring the feasibility of transitioning the
entry-level degree for the PTA to a bachelor's degree.
APTA supporting staff members
are Janet Crosier, PT, DPT, MEd, lead PTA services specialist; Janet Bezner,
PT, PhD, vice president of education and governance and administration; Doug
Clarke, accreditation PTA programs manager; and Libby Ross, director of
than 200 individuals volunteered to serve on the work group by submitting their
names to the Volunteer Interest Pool (VIP). APTA expects to engage additional
members in the data collection process.