The US Department of Health and Human Services (HHS) has released the final rule with comment period that will implement new provider screening and enforcement measures aimed at reducing fraudulent providers and suppliers from enrolling in Medicare, Medicaid, and the Children's Health Insurance Program (CHIP). The final rule also grants these federal programs authority to suspend payments when a credible allegation of fraud is being investigated.

As the federal government continues the process of implementing the Patient Protection and Affordable Care Act and Health Care and Education Reconciliation Act of 2010 (known collectively as the Affordable Care Act), APTA will provide a snapshot of the regulations and other items of importance to physical therapy. Screening and Enrollment Final Rule Aimed at Preventing Fraud: The US Department of Health and Human Services (HHS) has released the final rule with comment period that will implement new provider screening and enforcement measures aimed at reducing fraudulent providers and suppliers from enrolling in Medicare, Medicaid, and the Children's Health Insurance Program (CHIP). The final rule also grants these federal programs authority to suspend payments when a credible allegation of fraud is being investigated. The final rule: * Creates a rigorous screening process for providers and suppliers enrolling in Medicare, Medicaid, and CHIP that have been identified in the past as posing a higher risk of fraud, for example durable medical equipment suppliers. * Requires new enrollment processes for Medicaid and CHIP providers. States will have to screen providers who order and refer to Medicaid beneficiaries. Providers who have been excluded from Medicare or any state's Medicaid or CHIP program will be barred from all Medicaid and CHIP programs. * Temporarily stops enrollment of new providers and suppliers if a trend is identified in a category of providers or geographic area, as long as patients' access to care will not be affected. * Temporarily stops payments to providers and suppliers in cases of suspected fraud. A copy of the regulation is on display at the Federal Register and may be downloaded at www.ofr.gov/inspection.aspx. More information can be found at www.HealthCare.gov, an HHS Web portal. HHS also released a report this week on record-high fraud recovery efforts for fiscal year 2010. Read more and access the report in today's News Now article "DOJ and HHS Fraud Efforts Recover Record Amount in FY 2010." APTA is carefully analyzing all of the implementing regulations related to health care reform to determine their impact on physical therapy. To learn more about these and other regulations related to health care reform, visit APTA's Web site.

Source: PT IN MOTION

Medicare Open Forum - Regular BannerMedicare Open Forum - Small Banner
  • CMS’s Final Bow: The 2019 Final Rule Image

    articleNov 5, 2018 | 8 min. read

    CMS’s Final Bow: The 2019 Final Rule

    Last week, the Centers for Medicare and Medicaid Services (CMS) published its 2019 final rule . Clocking in at just over 2,300 pages, the final rule isn't exactly a light read—especially because the legal lingo can be harder to interpret than Shakespearean verse. Luckily, we have the script—with all its twists and turns—decoded and ready for you to review. Here's the synopsis of all the physical therapy, occupational therapy, and speech-language pathology Medicare changes for 2019: Out, …

  • 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 …

  • This Week in PT News, July 18 Image

    articleJul 18, 2014 | 1 min. read

    This Week in PT News, July 18

    CMS Releases Proposed 2015 Medicare Physician Fee Schedule Earlier this week, the Centers for Medicare & Medicaid Services (CMS) released the proposed Medicare physician fee schedule for 2015. You can read highlights of the proposed rule and access a link to view the full version here . CMS will accept public comments on the rule until September 2, 2014, and the organization is expected to release the final fee schedule on or before November 1, 2014. ACL …

  • webinarAug 13, 2013

    Rehab Therapy Industry News

    In July, we hosted a webinar focused on rehab therapy industry news. This session covered an array of newsworthy and timely topics, including: Functional limitation reporting and other Medicare regulations Changes to HIPAA regulations Direct access Branding PT to general consumers ICD-10

  • articleDec 9, 2010 | 2 min. read

    The Medicare and Medicaid Extenders Act of 2010

    This legislation would prevent the scheduled 25.5% Medicare payment cut to physical therapists and other health care providers paid under the physician fee schedule. Today, the US House of Representatives passed Senate Amendment to H.R. 4994 , the Medicare and Medicaid Extenders Act of 2010 (by a vote of 409-2). This legislation would prevent the scheduled 25.5% Medicare payment cut to physical therapists and other health care providers paid under the physician fee schedule. The provision in …

  • New and Improved: Details on Sustainable Growth Rate Formula Replacement Image

    articleJun 1, 2015 | 3 min. read

    New and Improved: Details on Sustainable Growth Rate Formula Replacement

    Ding-dong—the Sustainable Growth Rate (SGR) formula is dead . As of April 16, 2015—after 17 temporary patches—the wizards in Washington have permanently repealed the flawed SGR formula that threatened to significantly cut Medicare payments. Now, when payments exceed the growth in per-capita gross domestic product, PTs will no longer face reduced payments. Instead, they can look forward to a bit more stability, simplicity, and cash flow for the next decade. The new payment determination process begins with …

  • articleSep 9, 2011 | 2 min. read

    Final Regulations for IDEA's Early Intervention Program Released

    On Tuesday, the US Department of Education released the long-awaited final regulations for the early intervention program under Part C of the Individuals with Disabilities Education Act (IDEA), a program that serves infants and toddlers through age 2 with developmental delays or conditions that have a high probability of resulting in developmental delays. These regulations will provide families, state agencies, early intervention service programs, and providers needed guidance. The department also released a notice of proposed rulemaking …

  • articleNov 18, 2010 | 4 min. read

    What PTs Should Know About 2011 Final Rule Medicare Changes

    Some major changes are headed our way in terms of the 2011 Medicare Final Rule on the Physician Fee schedule and Other Policies to be effective January 1, 2011.  The Rule included a number of provisions that have impact on outpatient therapy services. The net effect of the policies could lead to payment reductions of approximately 30%. If you see Medicare patients and they impact your revenue, there are several things to pay attention to and deal …

  • Hot Out of the Oven: Highlights of the 2017 Final Rule for PTs, OTs, and SLPs Image

    articleNov 9, 2016 | 8 min. read

    Hot Out of the Oven: Highlights of the 2017 Final Rule for PTs, OTs, and SLPs

    Halloween may be over, but if you didn’t get your fill of scares, I’ve got the perfect activity for you: reading through 1,401 pages of pure Medicare gobbledygook. Screaming yet? (Or should I check back at around page 500?) I kid, of course; there’s no need for you to slog through this year’s extra meaty Final Rule —which details the Medicare fee schedule and other important Medicare regulatory and reimbursement changes for physical therapy, occupational therapy, and …

Achieve greatness in practice with the ultimate EMR for PTs, OTs, and SLPs.