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:

• H51000: The Procedure Code ____ is not a valid CPT or HCPCS Code for this Date of Service
• H51061: 'Procedure Modifier 1' ___ is not a valid CPT or HCPCS Modifier Code
• H51062: 'Procedure Modifier 2'____ is not a valid CPT or HCPCS Modifier Code
• H51063: 'Procedure Modifier 3' ____ is not a valid CPT or HCPCS Modifier Code
• H51064: 'Procedure Modifier 4' ____ is not a valid CPT or HCPCS Modifier Code
• H51108:  _______ is not a valid 'Line Level Adjustment Reason Code.'

(Where 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:

• G8978—G8999
• G9158—G9176
• G9186

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.

This 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.   

APTA 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 guide.

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: 

• School settings hold a realistic and evidence-based opportunity to increase physical activity among youth and should be a key part of a national strategy to increase physical activity.
• Preschool and child care centers that serve young children are an important setting in which to enhance physical activity.
• Changes involving the built environment and multiple sectors are promising.
• To advance efforts to increase physical activity among youth, key research gaps should be addressed.

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.    

Physical 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 healthy individuals.      

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," says CDC.

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.

CDC's website 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 nursing homes.

APTA 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.  

APTA 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 academic services.

More 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.