• articleJan 26, 2011 | 2 min. read

    "Improvement Standard" reason for denying treatment is brought to a lawsuit

    Center for Medicare Advocacy want to require Medicare to cover certain rehabilitative care, such as physical therapy, even when it is likely that there will be no "improvement" in the patient's condition. In recent months, the Department of Health and Human Services has faced a series of judicial challenges regarding its statutory and regulatory authority to deny coverage to Medicare beneficiaries for therapy services based on the conclusion that the patient is medically stable and the services …

  • articleJan 11, 2011 | 5 min. read

    Webinar Update from CMS

    The Centers for Medicare & Medicaid Services’ (CMS) Provider Communications Group will host a national provider conference call on the 2011 Physician Quality Reporting System and Electronic Prescribing (eRx) Incentive Program. The eRx Incentive Program is an incentive program for eligible professionals initially implemented in 2009 as a result of section 132(b) of the MIPPA.  The eRx Incentive Program promotes the adoption and use of eRx systems by individual eligible professionals and beginning with the 2010 eRx …

  • articleJan 11, 2011 | 1 min. read

    APTA recommends rejection of recommended work value for wound care

    APTA urges payments that accurately reflect the resources needed to provide services including wound care. In comments to the Centers for Medicare and Medicaid Services (CMS) on the 2011 final fee schedule rule, APTA strongly recommends that the agency reconsider its rejection of the Health Care Professionals Advisory Committee's (HCPAC) recommended work value for wound care codes. "Over the past few years, the HCPAC has been very thorough in its review of new, revised, and potentially misvalued …

  • articleJan 10, 2011 | 2 min. read

    Online calculators reflect new medicare fee schedule conversion factor

    APTA's online fee schedule calculator now reflects the $33.9764 conversion factor that will be used in 2011. To use these calculators , click here. Updated Fee Schedule and MPPR Calculators Now Available APTA has updated its Medicare fee schedule calculator to reflect the $33.9764 conversion factor that will be used in 2011. The fee schedule calculator provides the payment amount for each CPT code based on geographic location. It does not guarantee that a local contractor will …

  • articleJan 10, 2011 | 2 min. read

    46 states give direct access to a therapy evaluation without a referral

    With the addition of Hawaii, 46 states now give patients the ability to get an evaluation from physical therapists without having to get a referral from their doctor. Patients in Hawaii now can be evaluated and treated by physical therapists without first having to obtain a physician referral. With the passage of new State Board of Physical Therapy regulations last month, Hawaii becomes the 46th state to achieve direct access. On November 9, 2010, the Hawaii Board …

  • articleJan 2, 2011 | 2 min. read

    Washington State Governor Restored Medicaid Funding for Therapy

    Workign together a number of assocaitions provided the governor with "concrete suggestions" including alternative cuts that gave Washington's governor the information she needed to restore therapy to the Medicaid budget. On December 17, Washington Gov Christine Gregoire restored funding for adult physical therapy services as part of her supplemental budget recommendations to the FY2011 state budget. Gregoire withdrew threatened cuts that would have eliminated physical, occupational, and speech therapies. The restored funding prevents elimination of physical therapy, …

  • articleJan 2, 2011 | 2 min. read

    Multiple Procedure Payment Reduction (MPPR) of 5% for Therapy Services

    CMS will make full payment for the therapy service or unit with the highest practice expense value and reduce payment of the practice expense component by 20% in the office setting and 25% in institutional settings for the second and subsequent procedures or units of service furnished during the same day for the same patient. Based on policy changes required by the Physician Payment and Therapy Relief Act of 2010, the Centers for Medicare and Medicaid Services …

  • articleJan 2, 2011 | 2 min. read

    Medicare and Medicaid Extenders Act of 2010 Update

    The legislation recently stopped the 24.9% payment cut from occurring on January 1, 2011. However, CMS announced that the conversion factor used to update payment for next year will be $33.9764 instead of the $36.8729 conversion factor that was in effect in 2010. The Centers for Medicare and Medicaid Services (CMS) this week released corrected payment amounts for 2011 that incorporate the changes included in the Medicare and Medicaid Extenders Act of 2010 that was signed into …

  • articleDec 21, 2010 | 2 min. read

    APTA defines "essential" in the context of essential benefits

    What is your interpretation of the word “essential” in the context of an essential benefit package? The official response from APTA: “Essential,” in the context of essential benefits provided under insurance plans, should mean benefits that are available and accessible to all individuals with coverage without increased premiums and co-payments. Essential benefits include, but are not limited, to preventing the spread of disease, improving and/or eradicating certain medical conditions or disease states, improving and minimizing the effects …

  • articleDec 21, 2010 | 2 min. read

    Physical Therapists should be included in the ACO model to be fully effective

    An Accountable Care Organization (ACO), is an organization of health care providers that agrees to be accountable for the quality, cost, and overall care of Medicare beneficiaries who are enrolled in the traditional fee-for-service program who are assigned to it. APTA argues that PTs should be included in the ACO model in order to continue quality of care throughout different treatment settings. For an accountable care organization (ACO) model to be successful, it will be essential that …

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