Tag Archives: Therapy

OIG Recommends Improvements to SNF Billing for Changes in Therapy

In FYs 2011 and 2012, CMS adopted new patient assessments for skilled nursing facilities (SNFs) that were intended to capture when beneficiaries start therapy, end therapy, and decrease or increase therapy. The HHS Office of Inspector General (OIG) has questioned the effectiveness of these complex policies, however, noting that SNFs reviewed often used the start … Continue Reading

Hospital Outpatient Payment Advisory Panel Meeting (March 9-10, 2015)

The Advisory Panel on Hospital Outpatient Payment will be holding its first semi-annual meeting for 2015 on March 9-10, 2015. The purpose of the Panel is to advise CMS on (1) the clinical integrity of the Ambulatory Payment Classification groups and their associated weights, and (2) hospital outpatient therapeutic services supervision issues. Registration will be open … Continue Reading

CMS Issues FY 2015 Medicare SNF PPS Final Rule

This post was written by Susan Edwards. The Centers for Medicare & Medicaid Services (CMS) published the final FY 2015 Medicare skilled nursing facility (SNF) prospective payment system (PPS) rule on August 5, 2014 (Final Rule). The Final Rule largely adopts the proposals set forth in the FY 2015 proposed SNF PPS rule (Proposed Rule). CMS estimates that the … Continue Reading

CMS Publishes Final FY 2015 Update to Medicare IRF PPS

On August 6, 2014, CMS published its final rule to update Medicare payment policies under the inpatient rehabilitation facility (IRF) PPS for FY 2015. Under the final rule, CMS expects aggregate Medicare payments to IRFs will increase by $180 million, or 2.4%, compared to 2014 levels. The standard payment conversion factor for discharges for FY … Continue Reading

CMS Issues FY 2015 Medicare SNF PPS Proposed Rule

This post was written by Susan Edwards. The Centers for Medicare & Medicaid Services (CMS) published the fiscal year (FY) 2015 proposed skilled nursing facility (SNF) prospective payment system (PPS) rule on May 6, 2014 (Proposed Rule). CMS estimates that the Proposed Rule’s implementation would result in a $750 million increase in aggregate payments to SNFs during FY 2015 … Continue Reading

CMS Proposes Emergency Preparedness Requirements for Medicare/Medicaid Providers

On December 27, 2013, CMS published a proposed rule that would establish national emergency preparedness requirements for Medicare- and Medicaid-participating providers and suppliers to ensure that they can meet the needs of patients and residents during emergency situations, both natural and man-made. The proposed requirements cover four aspects of emergency preparedness: Risk assessment and planning: Providers and … Continue Reading

House Panel to Examine Medicare “Extenders” Policy

On January 9, 2014, the House Energy and Commerce Health Subcommittee is holding a hearing on “The Extenders Policies: What Are They and How Should They Continue Under a Permanent SGR (Sustainable Growth Rate) Repeal Landscape?” The so-called extenders are measures that secure the continuation of various temporary Medicare payment and policy revisions impacting hospitals, … Continue Reading

President Signs 2-Year Funding Bill with Medicare SGR Patch, Sequestration Extension for Medicare Providers

On December 26, 2013, President Obama signed into law H.J. Res. 59, the Bipartisan Budget Act of 2013, which includes the Pathway for SGR Reform Act of 2013 ("the Act"). In addition to establishing federal budget targets for fiscal years (FYs) 2014 and 2015, the Act includes a number of provisions impacting the Medicare and Medicaid programs. Most notably, the Act provides a short-term reprieve from a looming Medicare physician fee schedule cut while lawmakers work to finalize a longer-term solution. It also extends Medicare provider payment cuts under existing sequestration authority for two years and makes a variety of other policy changes. The Act's major Medicare and Medicaid provisions are summarized in our full post.… Continue Reading

CMS Updates Medicare Physician Fee Schedule, Other Part B Policies for CY 2014

On December 10, 2013, CMS published its final rule updating Medicare physician fee schedule (PFS) rates and polices for calendar year (CY) 2014, which includes a 20.1% across-the-board cut in PFS rates in 2014 (down from 24.4% projected under the proposed rule). The cuts are largely due to the statutory Sustainable Growth Rate (SGR) update formula, … Continue Reading

CMS Publishes Final FY 2014 Medicare SNF PPS Rates, Policies

On August 6, 2013, CMS published a final rule to update Medicare skilled nursing facility (SNF) PPS rates for FY 2014 and make other updates to SNF reimbursement policy. CMS estimates that the final rule will increase aggregate Medicare payments to SNFs in FY 2014 by $470 million, or 1.3%, compared to FY 2013 rates. … Continue Reading

CMS Proposes Updates to Medicare Physician Fee Schedule, Other Part B Policies for CY 2014

On July 19, 2013, the Centers for Medicare & Medicaid Services (CMS) published its proposed rule updating Medicare physician fee schedule (PFS) rates and polices for calendar year (CY) 2014. CMS projects that PFS payments will be reduced by approximately 24.4% in 2014, largely due to the statutory Sustainable Growth Rate (SGR) update formula (although … Continue Reading

MedPAC Report to Congress on Delivery Reform

The Medicare Payment Advisory Commission (MedPAC) has released its June 2013 Report to the Congress on Medicare and the Health Care Delivery System. The report examines a number of potential ways to reform Medicare, including the following:  Redesigning the Medicare benefit. MedPAC continues to discuss the concept of competitively determined plan contributions (CPC), under which … Continue Reading

CMS Updates Outpatient Therapy Limits, Coding Policy for 2013

CMS has announced that the CY 2013 Medicare outpatient therapy limit is $1900 for physical therapy (PT) and speech-language pathology (SLP) combined and $1900 for occupational therapy (OT). CMS also has updated the Medicare Claims Processing Manual and the Medicare Benefit Policy Manual to implement the Middle Class Tax Relief and Jobs Creation Act’s (MCTRJCA) claims-based … Continue Reading

MedPAC Meeting on Medicare Policy Issues (Nov. 1-2)

MedPAC is meeting on November 1 -2, 2012 to discuss a variety of Medicare policy issues, including: Medicare payment for ambulance services, reducing the hospitalization rate for Medicare beneficiaries receiving home health care, Medicare payment for outpatient therapy services, geographic adjustment of payments for the work of physicians and other health professional, the role of … Continue Reading

CMS Open Door Forum on Manual Medical Review of Therapy Claims (Sept. 5)

On September 5, 2012, CMS is hosting a Special Open Door Forum (ODF) on Manual Medical Review of Therapy Claims. The call will provide an opportunity for providers to ask questions about the documentation requirements associated with the mandated manual medical review of therapy services from October 1-December 31, 2012 that was enacted by the … Continue Reading

CMS Issues Proposed OPPS, ASC Policies for 2013

The Centers for Medicare & Medicaid Services (CMS) has issued a proposed rule that would update Medicare payment and other policies for the hospital outpatient prospective payment system (OPPS) and ambulatory surgical centers (ASCs) for calendar year (CY) 2013. The proposed rule also would update Medicare inpatient rehabilitation facility (IRF) quality reporting program policies and … Continue Reading

CMS Proposes Update to 2013 Medicare Physician Rates, Other Part B Policies

On July 30, 2012, CMS is publishing a proposed rule updating the Medicare physician fee schedule (MPFS) for 2013 and modifying numerous other Medicare Part B policies. Most significantly, the proposed rule would impose a 27% across-the-board cut in MPFS payments, largely due to the statutory Sustainable Growth Rate (SGR) update formula (although Congress is … Continue Reading

House Approves Tax/Jobs Bill with Medicare Provisions; Fate Uncertain

On December 13, 2011, the House of Representatives approved H.R. 3630, the Middle Class Tax Relief and Job Creation Act of 2011, a wide-ranging bill making payroll tax, unemployment insurance, energy, and other policy changes. Among many other things, the bill would avert a scheduled 27.4% cut in Medicare physician fee schedule (MPFS) payments in … Continue Reading
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