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  • CMS Delays Prepayment Review and Prior Authorization of PMD Demonstration

    The Centers for Medicare and Medicaid Services (CMS) recently delayed the implementation of the Prepayment Review and Prior Authorization for Power Mobility Devices (PMD) demonstration so it can carefully consider the many comments/suggestions regarding the demonstration, including those from APTA. The demonstration was scheduled to begin January 1. The agency will provide at least 30 days’ notice before the demonstration begins.

    In its comments, APTA called for CMS to eliminate the prepayment review phase (Phase I) and delay implementation of the demonstration until the prior authorization phase (Phase II) is available for PMD claims.

    CMS also delayed the Recovery Audit Prepayment Review demonstration.

    APTA members are encouraged to use resources from the National Coalition for Assistive and Rehab Technology (NCART) when advocating for policy changes that are needed to provide adequate access to Complex Rehab Technology (CRT) with legislators, the public, private third‐party payers, and other policy makers. An educational video titled "Complex Rehab Technology -- Essential for health. Essential for life" provides an introduction from the perspectives of people who rely on CRT for their health and independence, physicians that prescribe it, and consumer organizations that work to protect access to CRT..

    New Medicare Conditions of Participation Guidelines for Hospital-based Outpatient Settings

    APTA currently is in discussion with the Centers for Medicare and Medicaid Services (CMS) regarding new interpretive guidelines that were issued November 18, 2011. This recent interpretation states that rehabilitation services must be ordered by a qualified practitioner who is responsible for the care of the patient and who has medical staff privileges to write orders for these services. CMS' Conditions of Participation rules apply to both inpatient and outpatient hospital-based settings and apply not only to Medicare beneficiaries but to all patients who receive services at the hospital. 

    APTA believes that this new interpretation is inconsistent with the current regulation and that it poses problems for physical therapists and their patients in hospital-based settings. The association is working diligently to get further clarification from CMS and will keep members updated as soon as more information is available.

    New in the Literature: Distal Sensorimotor Polyneuropathy (Diabetes Res Clin Pract. 2011 Nov 28. [Epub ahead of print])

    Distal sensorimotor polyneuropathy (DPN) results in a remarkable functional imbalance that may expose patients with diabetic neuropathy to danger of falling during daily activities and becomes more severe as the severity of neuropathy aggravates, say authors of an article published online in Diabetes Research and Clinical Practice.    

    The authors designed a case-control study to test the ability of 214 patients with DPN and healthy people to control functional balance using the Berg Balance Scale (BBS). Furthermore, the correlation between diabetic neuropathy examination (DNE) and BBS scores were calculated using Spearman's correlation coefficient. Comparison of 2 groups showed a significant decline in the overall score of BBS in patients with DPN versus the healthy control group. The most challenging tasks for patients with DNP were single leg stance, tandem standing, and forward reaching, followed by standing unsupported with feet together, sit to stand, stand to sit, transfers, standing unsupported with closed eyes, and placing the alternative foot on a step or stool while standing unsupported. There was a significant strong negative (r=-0.77) correlation between DNE and BBS scores.

    Videos Explain Concepts of Health Care Reform

    The Robert Wood Johnson Foundation's new series of animated educational videos aim to help patients and health care consumers understand how the new benefits and provisions of the Affordable Care Act (ACA) will affect them. The short videos tackle 5 common terms of ACA implementation. Share the videos with patients, friends, and family or post them to your Web site to help people gain a clearer understanding of what the law means for them.

    Prepare for 2012 Policies and Regulations: Register Today for Coding Seminars

    APTA's Coding, Payment & Practice Applications for Outpatient Rehabilitation Services seminars will kick off later this month. Don't miss this opportunity to attend 1 of 4 seminars in a city near you and help prepare for changes in 2012.    

    This 2-day course is designed to educate physical therapy professionals and their administrative staff about the best possible methods to deal with changing policies and regulations that affect outpatient therapy services. The seminar provides vital information that physical therapists, physical therapist assistants, and administrative staff need to know in applying these methods to everyday practice. Case studies will demonstrate best practices in the areas of coding, documentation, and compliance with third-party policies. Valuable resources will help attendees navigate through the health care reform environment. 

    The first seminar will be held January 20-21 in Fort Lauderdale, Florida. Others will follow February 24-25 in Baltimore, March 16-17 in Kansas City, Missouri, and April 20-21 in San Francisco.