CMS announced last evening that as of April 1, recovery audit contractors (RACs) will conduct manual medical review (MMR) of outpatient therapy services, including physical therapy, for outpatient therapy claims that exceed $3,700.
In the additional guidance on MMR released last night, CMS said that RACS will complete 2 types of review for claims processed on or after April 1, 2013—prepayment review for states within the Recovery Audit Prepayment Review Demonstration, and immediate postpayment review for the remaining states.
APTA is gathering additional information regarding this MMR policy to further inform members. In addition, APTA will meet with CMS officials and Congress to address concerns about the challenges this process will present for both providers and patients. For continued updates on this and other changes to Medicare policy occurring this year, visit APTA's 2013 Medicare Changes website.
The New England Journal of Medicine (NEJM) study showing that physical therapy is just as effective as surgery in patients with meniscal tears and osteoarthritis (OA) of the knee "should help change practice in the management of symptomatic meniscal tears in patients with knee osteoarthritis," APTA President Paul A. Rockar Jr, PT, DPT, MS, said in response to the study. "Surgery may not always be the best first course of action," Rockar stated. "A physical therapist, in many cases, can help patients avoid the often unnecessary risks and expenses of surgery."
An APTA press release quotes APTA member Clare Safran-Norton, PT, PhD, OCS, lead physical therapist in the study, who said their findings "suggest that a course of physical therapy in this patient population may be a good first choice … These findings should help surgeons, physicians, physical therapists, and patients in decision-making regarding their treatment options."
The Meniscal Tear in Osteoarthritis Research (METEOR) trial, widely publicized after appearing in NEJM this week, showed no significant differences in functional improvement after 6-12 months between patients who underwent surgery with postoperative physical therapy and those who received standardized physical therapy alone.
APTA applauds the passage of new legislation on March 14 that has made Arkansas the third US state to limit patient copays and other forms of cost sharing for services provided by physical therapists. Senate Bill 277, which was heavily promoted by the Arkansas Physical Therapy Association (ArPTA), APTA's chapter in that state, was signed into law by Gov Mike Beebe. As a result, patients will now pay less out of their own pockets when they visit a physical therapist, resulting in improved access to vital health care.
Legislation introduced this week in Congress would authorize physical therapists to participate in the National Health Service Corps (NHSC) Loan Repayment Program and add for the first time to the Corps a component to provide for rehabilitative care. The Physical Therapist Workforce and Patient Access Act of 2013 was introduced as HR 1252 by Reps John Shimkus (R-IL) and Diana DeGette (D-CO); S602 was introduced by Sens Jon Tester (D-MT) and Roger Wicker (R-MS). NHSC serves as a lifeline to millions of patients living in rural and underserved communities, and inclusion of physical therapists in the loan repayment program is one of APTA's public policy priorities.
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