New Medicare Conditions of Participation Rehabilitation Guidelines for Hospital-based Outpatient Settings:Transmittal 72 on 1/24/2012

Description: The Centers for Medicare and Medicaid Services (CMS) issued new interpretative guidelines (Transmittal 72) on November 18, 2011 for rehabilitation services provided in hospitals.

New Medicare Conditions of Participation Guidelines: Problematic for Hospital-based Outpatient Settings on 1/6/2012

Description: The American Physical Therapy Association (APTA) currently is in discussion with the Centers for Medicare and Medicaid Services (CMS) regarding new interpretive guidelines that were issued November 18, 2011. This recent interpretation states that rehabilitation services must be ordered by a qualified practitioner who is responsible for the care of the patient and who has medical staff privileges to write orders for these services. CMS' Conditions of Participation rules apply to both inpatient and outpatient hospital-based settings and apply not only to Medicare beneficiaries but to all patients who receive services at the hospital.

APTA believes that this new interpretation is inconsistent with the current regulation and that it poses problems for physical therapists and their patients in hospital-based settings. The association indicates it is working diligently to get further clarification from CMS and will keep members updated as soon as more information is available.

Payroll Tax Extension Legislation Impacts 2012 Conversion Factor on 1/5/2012

Description: The payroll tax extension legislation that was passed by Congress and signed by the President on Dec. 23, 2011 (Public Law 112-078) delayed the 27.4% Medicare pay cut due to the SGR formula for two months. It also extended the floor on the work geographic practice cost index (GPCI) and certain other policies. However, the Centers for Medicare & Medicaid Services (CMS) has confirmed that all of the other changes that were included in the Medicare physician payment final rule for 2012 will still take effect. As a result, providers should not expect that payment rates will remain unchanged, as numerous changes are being made in the relative value units, GPCIs, electronic prescribing and quality reporting programs, and multiple procedure payment rules for 2012. All of these changes will take effect as scheduled for dates of service beginning Jan. 1, 2012.

Legislation Passed to Prevent Caps and Cuts until February 29, 2012 on 12/23/2011

Description: The House of Representatives passed legislation to extend the payroll tax break, fee schedule update, rural payment update, therapy cap exception extension and other end year provisions this morning. The Senate also passed the measure this morning and was signed by the President this afternoon. This will prevent the 27.4% fee schedule reduction on January 1, 2012, maintain the 1.0 GPCI floor on rural payments, and provides for a continuation of the exceptions process to the $1880 therapy cap until February 29, 2012. Therapists will actually see a small increase in payment amounts for certain procedures due to the scheduled increase in the practice expense values as published in the 2012 MPFS Final Rule to take effect January 1, 2012.

When Congress returns next year, attention will turn to the conference committee assigned to hammer out a deal between the two chambers to prevent these cuts and caps effective March 1, 2012. But the differences remain large over how to pay for the deal. The American Physical Therapy Association has emphasized that the profession must continue to remain vigilant to prevent this from happening next year.

CMS Provides Further Information Regarding Medicare Claims Processing Issue Related to Part B Services for Skilled Nursing Facility (SNF) Patients on 12/22/2011

Description: Because of a claims processing problem, some Part B claims for SNF patients submitted to Medicare during October and November 2011 have been erroneously denied by Medicare’s claims processing system. In other instances, the claims processing system has paid and then identified a Medicare “overpayment” on these claims in error.

CMS is working with its contractors to identify all claims that were denied in error as well as any overpayments that were identified erroneously and resulted in a demand letter. The denied claims will be reprocessed and the erroneous overpayments adjusted so that in most cases there will be no impact upon the provider. Where a demand letter was sent in error, the Medicare Claims Administration Contractor (MAC) will send you an acknowledgement letter that the overpayment was removed.

In a few cases, an overpayment may have been collected prior to the MAC having determined that the demand letter was sent in error. In such instances, the MAC will automatically process an adjustment. We are asking providers not to appeal these claims at this time. Submitting an appeal may slow down the correct adjustment of your claim. (Please note that if another valid overpayment exists, the money collected will first be applied to it and the provider will be notified accordingly.)

Your MAC will advise you through its website and its listservs when it expects to complete this process so that you can anticipate when your claims will be adjusted or your erroneous overpayments