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
APTA will advocate to fix this flawed policy. The
association soon will call on APTA members to help in this effort.
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
The major points of clarification include:
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
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.
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
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
Watch this NBC video of Kirk's "45
monumental steps." To view photos of Kirk in rehabilitation, visit the Huffington Post.
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
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
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.
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