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 firstname.lastname@example.org.
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.
APTA's public policy priorities for 2013-2014 were posted this week on APTA's website for members and public audiences, representing issues to which APTA will direct its efforts in the 113th Congress and federal agencies. Initially adopted by the Board of Directors in November 2012, the priority list has been adjusted to reflect implications of the fiscal cliff legislation and sequestration, such as the multiple procedural payment reduction (MPPR) and a Blue-Ribbon Commission report on the future of rehabilitation research at the National Institutes of Health.
Every 2 years, APTA, through its Public Policy and Advocacy Committee, develops public policy priorities by gathering extensive member feedback on the issues that matter to your practice and patients. The committee will continue to update and revise the priorities as challenges and opportunities emerge over the next 2 years.
This list does not include all issues for which the association is advocating to advance physical therapy practice, education, and research; however, these issues were identified as priorities by members, confirmed by APTA leaders, and implemented by APTA staff. As these issues become active in Congress or federal agencies, APTA will communicate with and activate its membership to ensure physical therapy is best represented. To stay informed, join APTA's grassroots network, PTeam.
Also consider coming to Washington, DC, to educate and lobby your member of Congress on these priorities, including the immediate challenges facing physical therapist payment under Medicare, such as the therapy caps, MPPR, and impact of the sequester cuts. Join your engaged colleagues at the annual Federal Advocacy Forum, April 14-16. Learn more and register.
For the second time in 6 months, Medicare has erred in calculating hospital readmission penalties for more than 1,000 of the nation's hospitals, says a Kaiser Health News article.
As a result, Medicare has slightly lessened its readmissions penalties for 1,246 hospitals as part of its Hospital Readmissions Reduction Program. The penalty imposed on St Claire Regional Medical Center in Morehead, Kentucky, will drop the most, from 0.93% to 0.72% of every payment Medicare makes for a patient during the fiscal year that ends in September.
Medicare also modestly increased the penalties for 226 hospitals. LaSalle General Hospital in Jena, Louisiana, will see its penalty grow by the greatest percentage. LaSalle will lose 0.84% of each Medicare payment per patient, instead of the 0.65% reduction Medicare previously announced.
The payment changes for most hospitals were small, averaging .03% of each reimbursement. Overall, hospitals will pay $10 million less in penalties than previously calculated, for a total of $280 million this year. The changes are retroactive to October 2012, when the program began.
The readmission program, created by the Afforadable Care Act, is looking at the number of patients with heart attack, heart failure, and pneumonia who return to the hospital within 30 days of discharge. Hospitals with more readmissions than Medicare expected given their mix of patients are penalized by losing up to 1% of their regular payments. The maximum penalty ramps up to 2% starting this October and grows to 3% in 2014.
Medicare originally released the penalties last August, but then revised them at the end of September after determining that it had left some patients out of its calculations. That change increased penalties for 1,422 hospitals and decreased them for 55 others.
This second correction brings many hospitals closer to where they originally were, says Kaiser. More than 320 hospitals that had their penalties altered in September now will have their initial penalties restored.
Physical therapists can help serve an important role in patient care transitions and care coordination and can help reduce readmissions by providing recommendations for the most appropriate level of care to the health care team prior to and during care transitions. For more information and to find clinical practice and patient education resources to reduce readmissions, visit APTA's Hospital Readmissions webpage.