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  • CMS Issues New Guidance on Applying Therapy Cap

    The Centers for Medicare and Medicaid Services (CMS) today issued a long-awaited transmittal (2457) implementing certain provisions of the Middle Class Tax Relief and Job Creation Act of 2012 (HR 3630) related to the therapy cap.

    Physical therapists should be aware of the following dates and requirements: 

    • Starting October 1, 2012, the cap will be applied to hospital outpatient settings until December 31, 2012. Critical access hospitals are excluded from the cap.
    • Claims processing requirements associated with the cap will apply to hospitals on/after October 1, 2012 (eg, the exceptions process using the KX modifier). However, in calculating the dollar amount accrued toward the cap beginning October 1, 2012, claims paid for hospital outpatient therapy services since January 1, 2012, will be included.
    • Contractors will provide the total amount accrued toward the therapy cap on all applicable screens and inquiry mechanisms.
    • Claims for services above the therapy cap for which an exception is not granted will be considered a benefit (statutory) denial, and therefore the beneficiary will be liable for payment for the services. It is advisable as a courtesy (but not mandatory) for the provider to give the patient an Advance Beneficiary Notice (ABN) in circumstances for which the patient may need to pay out of pocket.
    • Starting October 1, 2012, providers must identify on the claim form the physician/NPP certifying the therapy plan of care in the “referring provider” field. Claims processing instructions will indicate where this information is to be reported on the claim form. Claims will be returned as unprocessable if this information is not included.

    CMS will issue a Medlearn Matters article on these instructions shortly.

    Transmittal 2457 does not provide information on the medical review process. CMS is still in the process of determining how to proceed with implementation of manual medical review for claims that exceed $3,700.

    Alabama Becomes 47th Direct Access State

    Patients in Alabama will soon be able to be evaluated and, in certain cases, treated by physical therapists (PTs) without first having to obtain a physician referral. With the enactment of Alabama House Bill 163, Alabama becomes the 47th state to achieve some form of direct access. 

    HB 163, sponsored by state Rep Ed Henry and signed by Gov Robert Bentley yesterday, goes into effect July 1. Prior to implementation of HB 163, PTs were prohibited from performing a physical therapy evaluation unless the patient had a referral. The new law provides for direct access to evaluation, fitness, wellness, and prevention services, and for treatment under certain conditions.

    The legislation, which faced significant opposition, primarily from physician groups, is the culmination of many years of difficult work by the Alabama Chapter. Despite numerous obstacles, fierce and well-financed opponents, and the devastation of the April 27, 2011, tornado, the chapter was able to obtain a compromise from opponents on the bill that allowed its passage by the legislature. Per APTA's Strategic Plan, the chapter was provided direct access grants in 2011 and 2012 from the association.

    Read more about the chapter's advocacy efforts in APTA's press release.

    Alabama PT Rally - May 1, 2012
    Emmett Parker, PT, MS, ATC, legislative chair for the Alabama Chapter, addresses attendees at a rally in 2011 at the Alabama State House in support of direct access to physical therapist services. 

    Call for Nominations: FSBPT Examination Committees

    APTA encourages physical therapist members to consider serving on a Federation of State Boards of Physical Therapy (FSBPT) examination committee. Under the 1989 Transfer Agreement of the physical therapy licensing examination and a more recent settlement agreement, APTA is entitled to seat candidates for at least 40% of the positions on the FSBPT Examination Development Committees. This year APTA will be providing 1 nominee for the Examination Development Committee-PTA (EDC-PTA), and 1 nominee for the Item Bank Review Committee-PT (IBRC-PT).

    APTA nominees to all committees must be physical therapists and active APTA members. Experience as National Physical Therapy Examinations (NPTE) item writers or American Board of Physical Therapy Specialties (ABPTS) writers is desired but not required. For the EDC-PTA, the nominees must have expertise in neuromuscular, cardiovascular/pulmonary, musculoskeletal, or pediatrics; for the IBRC-PT, the nominees must have expertise in pediatrics, musculoskeletal or neuromuscular.

    To apply for nomination, complete and submit a Personal Information Form and a current résumé/CV by May 30 to Brandy Bradley in the Clinical Practice Department.