Though a House-approved bill to end the flawed sustainable growth rate (SGR) is almost certain to be a nonstarter in the Senate, a Senate bill that would end both the SGR and the therapy cap is now gaining momentum and is the focus of renewed grassroots advocacy efforts from APTA and other organizations. Physical therapists (PTs), physical therapist assistants (PTAs), physical therapy students, and supporters are being urged to contact legislators to push for passage.
On March 14, the House voted 238-181 to approve a bill that would pay for the cost of SGR repeal by delaying enforcement of the individual mandate in the Affordable Care Act (ACA). The political implications of the bill are widely viewed as unacceptable to the Democratic-controlled Senate, which so far has refused to take up the bill. The White House has threatened a veto of the bill if it should pass both houses.
As the House bill was being announced, Senate insiders described a new effort to draft a bill that would end not just the SGR, but the therapy cap as well—something not addressed in the House bill. The bill, S. 2110, is scheduled to go to the floor of the Senate during the week of March 24.
The coming days will be crucial ones for supporters of an end to the SGR and therapy cap, and APTA's advocacy team has issued e-mail alerts highlighting the need for grassroots shows of support for the bill. Additionally, supporters are being asked to contact House members to reemphasize the importance of repeal. Current exceptions to the SGR and therapy cap will expire on March 31.
A permanent end to the therapy cap and SGR could be closer than ever. Now is the time for action to help legislators understand the importance of repeal for providers and their patients. APTA members can take action via the Legislative Action Center and nonmembers and the public can take action via the Patient Action Center. APTA members, nonmembers, and patients can also take action using the APTA Action app. Members interested in joining APTA's advocacy efforts can also sign up for PTeam.
The Centers for Medicare and Medicaid Services (CMS) is looking for volunteers to test systems (.pdf) built around the International Classifications of Diseases – 10th revision (ICD-10) codes that will be implemented throughout the Medicare and Medicaid systems in October. Practices that participate in the end-to-end testing this summer could find the experience to be a good way of assessing their own readiness for the transition.
The tests, set for July 21–25, will involve a select group of providers working with Medicare Administrative Contractors (MACs), and the Common Electronic Data Interchange (CEDI) contractor. The testing will include submission of test claims to CMS with ICD-10 codes and the provider’s receipt of a Remittance Advice (RA) document that explains the adjudication of the claims. CMS wants to verify that:
The sample will be selected from providers, suppliers, and other submitters who volunteer to participate. CMS intends to create a broad nationwide sample that represents a mix of provider, claims, and submitter types. Providers interested in volunteering can sign up by filling out an interest form at the appropriate MAC website. Deadline for submission is March 24.
Need more information on what the change to ICD-10 means for your practice? Visit the APTA ICD-10 webpage, which includes background, resources, and a pre-recorded webinar, "Are You Ready to Move from ICD-9 to ICD-10?"
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