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  • CMS Issues Interim Instructions for Manual Medical Review Process for 2013

    Yesterday, the Centers for Medicare and Medicaid Services (CMS) issued interim guidance on how the manual medical review process will be implemented in 2013 for outpatient therapy claims that exceed $3,700.     

    From October 1, 2012, through December 31, 2012, CMS used a prior approval process at $3,700 under which providers would submit a request to their Medicare Administrative Contractors (MAC) for approval of up to 20 visits. With the request, providers would include information from the patients' medical record (eg, progress reports, daily notes, plan of care) to support the need for the additional visits.      

    For 2013, CMS has replaced the prior approval process with prepayment review, at least for the interim. Under prepayment review, when the patient reaches $3,700 in outpatient therapy services, the MAC will send the provider an additional development request (ADR) asking him or her to submit documentation so that the MAC can determine whether the services are medically necessary. Typically under Medicare, MACs have 60 days to make a determination. However, CMS has requested that with regard to the therapy cap manual medical review process, MACs decide within 10 days of receipt of the documentation whether the services exceeding $3,700 will be paid.

    CMS currently is working on a long-term strategy for the manual medical review process. 

    Physical therapists should consult their MACs' websites for specific information about submitting documentation in response to an ADR.  

    PTJ Named Official Journal of Royal Dutch Society for Physical Therapy

    The Royal Dutch Society for Physical Therapy (KNGF) has made PTJ its official journal. KNGF members will have access to PTJ Online as one of its member benefits. Editor in Chief Rebecca Craik, PT, PhD, FAPTA, notes in her February editorial, "I am delighted to be entering into this relationship with our Dutch colleagues, [who have] made significant contributions to our understanding of the use of measurement tools to examine clinical effectiveness …, advanced our understanding of clinical practice guideline development and clinician adherence to guidelines, as well as our understanding of professional issues such as direct access, continuing education, and physical therapist consultation in primary care." Philip Van der Wees, PT, PhD, who is affiliated with the Scientific Institute for Quality of Healthcare at Radboud University Nijmegen Medical Center and with Maastricht University, was nominated by the Royal Dutch Society and appointed by Craik to serve on PTJ's Editorial Board; he will share his expertise in clinical practice guideline development and in examining clinician adherence to practice guidelines. Read more at http://ptjournal.apta.org/content/93/2/126.full.

    Member Opportunity to Serve on Scope of Practice Task Force

    APTA's newly established Scope of Practice Task Force is seeking members to develop recommendations to the Board of Directors on the appropriate role and authority of APTA in decisions on scope of practice in physical therapy and recommend a consistent process and criteria to establish current and future physical therapist scope of practice. Those who are interested should respond to the call by completing a volunteer interest profile found on the Volunteer Interest Pool webpage. The first step is creating a "profile" for service. After developing a profile, to be considered for this task force members must then access the "current opportunities for service page" and respond to the questions specific to this task force. The deadline to respond to this call is March 7. For more information on this task force, click on the link above or contact Karen Jost, PT, MS, senior payment specialist, payment and practice management.