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  • APTA Clarifies Impact of MPPR in Updated FAQ

    APTA has updated its Medicare Physician Fee Schedule FAQ to clarify the impact of the multiple procedure payment reduction (MPPR) on payment for therapy services.

    Set to be implemented on April 1, the provision applies the MPPR to therapy services at 50%, up from 20% for office settings and 25% for facility settings. APTA estimates the application of a 50% MPPR policy will reduce payments by approximately 6-7% in aggregate for outpatient therapy services. This reduction will be partially offset by a 4% increase in practice expense that resulted from the Centers for Medicare and Medicaid Services' use of new survey data of practice expenses conducted by APTA. The impact of the MPPR reduction on individual practices and facilities will vary depending on the CPT codes billed and the typical duration of the therapy sessions. To determine the impact on your practice, refer to APTA’s MPPR calculator, which can be used to determine payment rates for 2012 and 2013.

    APTA will advocate to fix this flawed policy. The association soon will call on APTA members to help in this effort.

    CMS Updates Functional Limitation Reporting Requirements

    The Centers for Medicare and Medicaid Services (CMS) has further clarified the regulations on the new functional limitation reporting requirements that were included in transmittal R2622CP and a new Medicare Learning Network resource. 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. All practice settings that provide outpatient therapy services must include this information on the claim form. These new functional limitation reporting requirements were implemented on January 1. To ensure a smooth transition, CMS sets forth a testing period January 1-July 1. After July 1, claims submitted without the appropriate G-codes and modifiers will be returned unpaid.

    The major points of clarification include:

    • Guidance on using the “Other PT/OT” functional limitation category
    • Submission of functional limitation data for more than 1 therapy plan of care
    • Reporting instructions for 1-time therapy visits
    • Information regarding remittance advice codes to indicate successful submission of the functional reporting data

    Additionally, CMS has released revisions to the Medicare Benefit Policy Manual that include the functional limitation reporting requirements (see related article titled "CMS Releases Updates to the Medicare Benefit Policy Manual"). 

    APTA has posted links to these documents on its functional limitation reporting webpage. The association also has updated the FAQ posted on the webpage, which provides resources to help members meet this new reporting requirement.    

    CMS Revises Medicare Benefit Policy Manual

    The Centers for Medicare and Medicaid Services (CMS) has revised the Medicare Benefit Policy Manual to include a change to the progress note requirement, which now is required at either a date chosen by the clinician or the 10th treatment day, whichever is shorter. Additionally, there is a new section dedicated the functional limitation reporting requirements that were implemented on January 1. Therapists are required to include functional limitation reporting information in their documentation. The functional impairments identified and expressed in the long-term treatment goals must be consistent with those used in the claims-based functional reporting using nonpayable G-codes and severity modifiers for services furnished on or after January 1. For more information, visit APTA's functional limitation reporting webpage.

    One Year After Stroke, Sen Kirk Climbs Capitol Steps

    On Thursday, Sen Mark Kirk (R-IL) returned to Capitol Hill for the first time since having a stroke in January 2012 that paralyzed the left side of his body. Kirk climbed the steps to the Capitol using a 4-prong cane and assisted by Vice President Joe Biden and Sen Joe Manchin (D-WV) while his colleagues in the 113th Congress cheered.

    Kirk was scheduled to hold a press conference Thursday with physicians and researchers from the Rehabilitation Institute of Chicago and Northwestern Memorial Hospital to discuss the treatment he underwent.

    APTA member Michael Klonowski, PT, DPT, PCS, who was Kirk's primary physical therapist in Chicago, told USA Today that he was "more emotional" than he thought he would be as he watched his former patient make the climb.

    "Seeing what he's done is absolutely inspiring," Klonowski said. "I've seen him go up tons of stairs. ... It was really something to see him do what he did today."

    In an interview published Wednesday in the Chicago Sun-Times  Kirk said that his experience with the health care system has given him a new perspective. He said that he plans to take a look at the Illinois Medicaid program, which he noted allows 11 rehab visits for patients with stroke.

    "Had I been limited to that, I would have had no chance to recover like I did," Kirk said. "So unlike before suffering the stroke, I’m much more focused on Medicaid and what my fellow citizens face."

    Watch this NBC video of Kirk's "45 monumental steps." To view photos of Kirk in rehabilitation, visit the Huffington Post.    

    Adults With Diabetes at Greater Risk for Fracture Hospitalization

    Adults diagnosed with diabetes are at significantly increased risk for fracture-related hospitalization, says a Medscape Medical News article based on the results from an analysis of data from a large, community-based study. 

    More than 15,100 patients between 45 and 64 years old participated in the Atherosclerosis Risk in Communities (ARIC) study, a 4-community study that began in 1987. There were a total of 1,078 fracture-related hospitalizations during the 20-year follow-up period. (Only fractures that resulted in inpatient hospitalization were captured in ARIC.)

    At baseline, 1,195 participants had been diagnosed with diabetes based on self-report, and 605 had undiagnosed diabetes according to their measured serum glucose values.

    Compared with the 13,340 study participants without diabetes, the incidence of fracture-related hospitalization was significantly greater among the group with diagnosed diabetes (6.6 vs 3.9 per 1,000 person-years of follow-up).

    The incidence of fracture hospitalization was higher among those with diagnosed diabetes compared with those without diabetes for all age groups. However, the fracture risk was not increased among those with undiagnosed diabetes compared with those without diabetes, the article says. 

    After adjustment for the covariates, diagnosed diabetes still was associated with a significantly increased risk for fracture hospitalization, with a hazard ratio (HR) of 1.74.

    However, also in the fully adjusted analysis, the fracture risk among those with undiagnosed diabetes was similar to that for those participants without diabetes (HR 1.12). 

    There also was a significant relationship with glycemic control. After adjustment, participants with diagnosed diabetes who had hemoglobin A1c values of 8% or greater had a significantly greater risk for fracture hospitalization than did those with A1c values less than 8% (HR 1.63). After further adjustment for diabetes medication use that risk was reduced (HR 1.50).

    The authors say further studies are needed to understand if exercise interventions or strategies to improve glycemic control while minimizing hypoglycemic episodes may prevent fractures among people with diabetes.

    The study was published online December 17 in Diabetes Care.