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  • Updated MMR Complaint Form, Proposed Rule Summaries Now on APTA.org

    New APTA web resources will help members stay up-to-date on Medicare policies and proposals:

    • To help members navigate the 2 types of manual medical review (MMR) of Medicare claims for patients whose annual therapy costs exceed $3,700, APTA has created an MMR State Resources page, including a map and a detailed explanation of the process. As of April 1, recovery auditor contractors (RACs) complete either prepayment review or postpayment review of applicable claims, depending on the state of the provider.
    • An updated Medicare Therapy Cap information page includes a link to the MMR State Resources page as well as to a revamped Manual Medical Review Complaint Form. APTA encourages members to complete this complaint form if they are experiencing problems with MMR. APTA staff will contact members within 2 business days of receiving the complaint form.
    • APTA has posted a summary for the proposed rule released by the Centers for Medicare and Medicaid Services (CMS) for the home health prospective payment system for 2014. The rule proposes to remove 2 categories of ICD-9-CM codes from the HH PPS Grouper; reduce the national, standardized 60-day episode rate of 3.5% annually 2014–2017; increase each of the per-visit payment rates for low-utilization payment adjustments of 3.5% annually 2014–2017; and add 2 claims-based quality measures. This proposed rule is open for comment until August 26.
    • APTA has posted a summary of the CMS proposed rule to revise the Medicare hospital outpatient prospective payment system (OPPS) and the Medicare ambulatory surgical center (ASC) payment system for 2014. Among other changes, the rule proposes to expand the categories of related items and services packaged into a single payment for a primary service under the OPPS, to make the OPPS more of a prospective payment system. Specifically, the proposed rule would add 7 categories of supporting services and create 29 comprehensive ambulatory payment classification groups (APCs) to replace 29 existing device-dependent APCs. This proposed rule is open for comment until September 6.

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