• News New Blog Banner

  • CMS Says ICD-10 Will Begin October 1, 2015

    Without much fanfare, the US Centers for Medicare and Medicaid Services (CMS) has announced that use of the International Classification of Diseases, 10th revision (ICD 10) will begin on October 1, 2015—the soonest possible date allowed in a law passed by Congress earlier this year.

    The news came by way of an acknowledgment in the CMS rule on inpatient and long-term hospital payments released earlier this week. In the Request for Public Comments on ICD-10-CM/PCS Transition, CMS writes that “The ICD-10-CM/PCS transition is scheduled to take place on October 1, 2015. After that date, we will collect nonelectronic health record-based quality measure data coded only in ICD-10-CM/PCS.”

    CMS will be issuing an interim final rule that will establish the October 2015 implementation date in the near future. The rule will also require HIPAA-covered entities to continue to use ICD-9-CM through September 30, 2015. CMS also announced that it is cancelling the end-to-end testing program scheduled for July 2014, and will engage in a new testing program next year.

    Originally, the US Department of Health and Human Services set an October 1, 2013, date for implementation of ICD-10 for all HIPAA-covered entities. In spring of 2012, HHS announced that it was moving that date back 1 year, to October 2014. Early this year, Congress included language delaying ICD-10 implementation until some point after October 1, 2015, in Medicare-related legislation that also prevented implementation of the flawed sustainable growth rate (SGR).

    APTA's ICD-10 webpage has resources to help physical therapists understand the transition to the new code set.

    CMS Releases Report on Alternative Payment Systems for Outpatient Therapy

    A long-awaited set of reports on outpatient therapy payment alternatives has been released by the US Centers for Medicare and Medicaid Services (CMS).

    According to CMS, its Developing Outpatient Therapy Payment Alternatives (DOTPA) project had 2 main purposes: "to identify, collect, and analyze therapy-related information tied to beneficiary need and the effectiveness of outpatient therapy services, and to explore payment method alternatives to the current financial caps on Medicare outpatient therapy services." Research for the report began in 2011.

    The report states that "The research presented here does not aim to provide a completed, finalized model for a new payment system. Instead, selected characteristics that exist for an alternative payment system are discussed within the context of [the diversity of outpatient therapy]."

    APTA staff is reviewing the reports and will use the findings to inform its decisions and recommendations around payment policy.

    Proposed CMS 2015 Payment Rules for Inpatient Rehabilitation Include 2.2% Increase

    Inpatient Rehabilitation Facilities (IRFs) will receive an additional $160 million in 2015, according to policy updates recently released by the US Centers for Medicare and Medicaid Services (CMS). In addition to the payment changes, the updates from CMS also make refinements to compliance lists, expand definitions of therapy, add new outcome measures, and create a new section on the patient assessment instruments (PAIs) for IRFs.

    The change to IRF payments amount to a 2.2% increase. The CMS changes will also:

    • Refine the presumptive compliance list for the 60% rule to remove diagnosis codes that solely focus on amputations
    • Provide definitions for individual therapy (1 therapist to 1 patient), group therapy (1 therapist to 2-6 patients performing same or different activities) and co-treatment (more than 1 therapist from different disciplines to 1 patient)
    • Create a new therapy information section on the IRF-PAI to record the number of individual, group, and co-treatment minutes for each therapy discipline for a 7-day period
    • Add an item to the IRF-PAI to record arthritis diagnoses that meet IRF severity and prior treatment requirements
    • Add 2 new outcomes to the IRF Quality Reporting Program for 2017 payment adjustments for noncompliance: Staphylococcus aureus and Clostridium difficile

    The proposed rule is on display at the Federal Register, and comments will be accepted until June 30, 2014. APTA will provide a detailed summary of the rule shortly and will be submitting comments on behalf of the association.

    Clinical Instructor Input Wanted on Clinical Reasoning Skills

    The American Council of Academic Physical Therapy (ACAPT)  is taking a close look at clinical reasoning skills in physical therapist doctoral education programs and needs to hear from clinical instructors.

    ACAPT's Clinical Reasoning Curricula and Assessment Research Consortium has posted a survey for clinical instructors, the results of which will inform its study titled "Exploration of Clinical Reasoning in Doctor of Physical Therapy Education." The consortium estimates that the survey takes about 5–10 minutes to complete.

    Names and other identifiers will not be associated with the information received from the survey. All information will be stored on the principal investigator's university-issued password-protected computer and stored in a locked office.

    Editor's note: A link previously included in this story has been disabled. Clinical instructors interested in participating in this survey should contact huhnka@shrp.rutgers.edu to request access to the survey instrument.

    CMS Releases Proposed SNF Payment Rules, Report on Alternative Payment Systems

    Medicare payments to skilled nursing facilities (SNFs) will increase by $750 million in 2015, according to the US Centers for Medicare and Medicaid Services (CMS), which recently released a proposed payment and policy update. Along with the update, CMS has issued a report on possible alternatives to the prospective payment system (PPS) used in SNFs. The rule is on display at the Federal Register, and comments will be accepted until June 30, 2014.

    The payment change amounts to a 2% increase for SNFs. In addition the proposed rule seeks to:

    • Revise change of therapy (COT) policies to allow residents formerly but not currently in a therapy resource utilization group (RUG) to be reclassified into a new therapy RUG through the use of a COT other Medicare required assessment (OMRA), though use of the COT OMRA for initial classification of patients into a therapy RUG will still be prohibited
    • Tighten up rules governing how states can use the civil monetary penalty, and increase transparency around how this use is tracked and shared
    • Provide data about the status of the SNF therapy payment research project and therapy utilization patterns captured on CMS minimum data sets

    APTA will provide a detailed summary of the rule shortly and will submit comments on behalf of the association

    In conjunction with the payment and policy updates, CMS also released its initial findings from a project that looked at possible alternatives to the SNF PPS. The report explores 4 alternatives: a patient characteristics model that uses patient information to group patients with similar characteristics, a hybrid model that blends patient characteristics and a resource-based pricing adjustment, a fee schedule model that bases payment on actual therapy use rather than resource use, and a competitive bidding model that prices therapy services through a bidding process.

    As recommended by the consulting firm hired to conduct the analysis, CMS has selected the patient characteristics and hybrid models as a foundation for an alternative system. The development phase will include initial drafting, analysis, feedback from an expert panel, and a final summary. APTA is conducting a thorough analysis of the report and will provide commentary on the report findings to CMS.

    First-Round Innovation 2.0 Project Descriptions Posted

    APTA has posted full descriptions of the 21 promising and innovative models for physical therapy care that will be explored at APTA headquarters May 8 – 9 as part of the association's Innovation 2.0 initiative. The projects entering this phase of the project were selected from almost 60 submissions after evaluation by an expert panel.

    During the upcoming workshop, these 21 models will receive valuable feedback from researchers and other clinicians. The models will then submit proposals with further detail to be considered for the final selection of applicants receiving funding and in-kind services to advance their models and promote the impact of physical therapy in the emerging health care environment.

    Innovation 2.0 is an initiative aimed at bolstering the impact of physical therapy in innovative and emerging models of health care such as accountable care organizations, bundled payment, direct access, patient-centered medical homes, prevention and health promotion, and value-based purchasing.