CMS announced last evening that as of April 1, recovery audit contractors (RACs) will conduct manual medical review (MMR) of outpatient therapy services, including physical therapy, for outpatient therapy claims that exceed $3,700.
In the additional guidance on MMR released last night, CMS said that RACS will complete 2 types of review for claims processed on or after April 1, 2013—prepayment review for states within the Recovery Audit Prepayment Review Demonstration, and immediate postpayment review for the remaining states.
APTA is gathering additional information regarding this MMR policy to further inform members. In addition, APTA will meet with CMS officials and Congress to address concerns about the challenges this process will present for both providers and patients. For continued updates on this and other changes to Medicare policy occurring this year, visit APTA's 2013 Medicare Changes website.
The New England Journal of Medicine (NEJM) study showing that physical therapy is just as effective as surgery in patients with meniscal tears and osteoarthritis (OA) of the knee "should help change practice in the management of symptomatic meniscal tears in patients with knee osteoarthritis," APTA President Paul A. Rockar Jr, PT, DPT, MS, said in response to the study. "Surgery may not always be the best first course of action," Rockar stated. "A physical therapist, in many cases, can help patients avoid the often unnecessary risks and expenses of surgery."
An APTA press release quotes APTA member Clare Safran-Norton, PT, PhD, OCS, lead physical therapist in the study, who said their findings "suggest that a course of physical therapy in this patient population may be a good first choice … These findings should help surgeons, physicians, physical therapists, and patients in decision-making regarding their treatment options."
The Meniscal Tear in Osteoarthritis Research (METEOR) trial, widely publicized after appearing in NEJM this week, showed no significant differences in functional improvement after 6-12 months between patients who underwent surgery with postoperative physical therapy and those who received standardized physical therapy alone.
APTA applauds the passage of new legislation on March 14 that has made Arkansas the third US state to limit patient copays and other forms of cost sharing for services provided by physical therapists. Senate Bill 277, which was heavily promoted by the Arkansas Physical Therapy Association (ArPTA), APTA's chapter in that state, was signed into law by Gov Mike Beebe. As a result, patients will now pay less out of their own pockets when they visit a physical therapist, resulting in improved access to vital health care.
Legislation introduced this week in Congress would authorize physical therapists to participate in the National Health Service Corps (NHSC) Loan Repayment Program and add for the first time to the Corps a component to provide for rehabilitative care. The Physical Therapist Workforce and Patient Access Act of 2013 was introduced as HR 1252 by Reps John Shimkus (R-IL) and Diana DeGette (D-CO); S602 was introduced by Sens Jon Tester (D-MT) and Roger Wicker (R-MS). NHSC serves as a lifeline to millions of patients living in rural and underserved communities, and inclusion of physical therapists in the loan repayment program is one of APTA's public policy priorities.
Physical therapists who submit Medicare Part B claims without proper functional limitation data, for services provided on or after January 1, 2013, soon will get feedback from the Centers for Medicare and Medicaid Services (CMS) reminding them of the new functional limitation reporting requirements. For claims processed April 1 through June 30, 2013, CMS will send Remittance Advice messages to providers whose claims lack the required data, alerting them to include the applicable G-codes and appropriate severity/complexity modifier on future specified claims.
Providers who bill certain CPT evaluation/reevaluation codes (the affected codes are: 92506, 92597, 92607, 92608, 92610, 92611, 92612, 92614, 92616, 96105, 96125, 97001, 97002, 97003, and 97004) and fail to submit functional limitation data will receive a remittance advice code of N566. Providers who bill the affected CPT codes and submit functional limitation codes (G8978-G8999, G9158-G9176, and G9186) without a severity modifier (CH-CN) will receive a remittance advice code of N565.
CMS published this information in transmittal RT1196OTN and in a Medicare Learning Network article.
CMS was mandated to collect information on claim forms regarding beneficiaries' function and condition, therapy services furnished, and outcomes achieved on patient function by the Middle Class Tax Relief Act of 2012. As of January 1, 2013, all practice settings that provide outpatient therapy services must include the functional limitation data on the claim form. To ensure a smooth transition, CMS set forth a testing period January 1 to July 1. After July 1, claims submitted without the appropriate G-codes and modifiers will be returned unpaid.
APTA has additional details and resources on these new requirements under its Medicare webpage.
In recognition of World Down Syndrome Day, today MoveForwardPT.com, APTA's official consumer information website, hosted an online radio show about the role of physical therapy in the development of people with Down syndrome.
In the episode, which was a Blog Talk Radio "Staff Pick" for March 21, APTA member Venita Lovelace-Chandler, PT, PhD, PCS, discusses how physical therapists help children with Down syndrome develop gross motor skills to achieve important physical developmental milestones that also benefit the child's social and cognitive maturation. She also provides tips for parents.
APTA issued a press release about the show and also promoted MoveForwardPT.com's Physical Therapist's Guide to Down Syndrome via social media.
Move Forward Radio airs approximately twice a month. Episodes are featured and archived at MoveForwardPT.com and can be streamed online via Blog Talk Radio or downloaded as a podcast via iTunes.
Previous episodes have covered conditions ranging from concussion to osteoporosis and explored settings ranging from aquatic physical therapy to physical therapy in the performing arts.
APTA members are encouraged to alert their patients to this series and other MoveForwardPT.com resources to help educate the public about the benefits of treatment by a physical therapist. Ideas for future episodes and other feedback can be e-mailed to email@example.com.
Attend APTA's first-ever online Virtual Career Fair on Tuesday, April 9, 1:00 pm-4:00 pm, ET. This live, online event is a great way for you to engage directly with employers about their current and future physical therapy opportunities.
Participate in the Virtual Career Fair for as long as you wish, chatting 1-on-1 with recruiters to discuss your background and experience, and their current and future career opportunities.
Space is limited, so register now.