See our previous post for more details of the Medicare changes.

a) Continues consistent use of the KX modifier when the cap ($1880 for 2012) is met provided the patient continues to meet the medically necessary requirement.

b) The Manual Medical Review will be reintroduced; starting on October 1st 2012, patients who have met or exceed just under twice the amount of the current cap, $3,700 in therapy expenditures will be subject to a manual medical review. The medical review will be similar to the process used following in 2006. The $3,700 threshold will be applied to both caps sperately, the combined PT/Speech cap and the OT cap.

c) Also starting October 1st, each claim must include the national provider identifier (NPI) of the physician who is reviewing the plan of care.

d) A big change for Hospital Outpatient Setting is that, for this year at least, the therapy cap along with the exception process will be applied to their outpatients.

e) No later than June 15, 2013, MedPAC shall submit to the House Energy and Commerce Committee, House Ways and Means Committee and the Senate Finance Committee a report on how to improve the outpatient therapy benefit. The report will include recommendations on how to reform the payment system so that the benefit is better designed to reflect individual acuity, condition and therapy needs of the patient. The report will examine private sector initiatives relating to outpatient therapy benefits.

e) Beginning January 1st, 2013, the Secretary (of HHS) shall implement a claims based data collection strategy that is designed to assist in reforming the Medicare payment system for outpatient therapy. (I thought this was already being done by CMS, but what do I know!). The system will be designed to provide for the collection of data on patient function during the course of therapy services in order to better understand patient condition and outcomes. In proposing and implementing such a strategy, the Secretary will consult with relevant stakeholders.

f) No later than May 1st, 2013, the Comptroller General shall issue a report to the House Committee on Energy and Commerce, the House Ways and Means Committee and the Senate Finance Committee on the implementation of the manual medical review process. The report shall include data on the number of individuals and claims subject to the process, the number of reviews conducted and the outcome of the reviews.

So we can breath a little easier. This bill is expected to pass both houses.

“report and return self-identified overpayments either within 60 days of the incorrect payment being identified or on the date when a corresponding cost report is due, whichever is later.”

The new announcement is one in a series of steps Medicare is taking to protect taxpayer dollars, including efforts to prevent overpayments from occurring. These efforts include letting private auditors working on behalf of Medicare catch wasteful spending before it happens,by expanding the use of Recovery Audit Contractors; testing changes to outdated hospital billing systems to help prevent over-billing; and changing processes for approving payments for medical equipment with high error rates.

A Medicare overpayment means any funds that a person receives or retains under Medicare to which the person is not entitled. Examples of overpayments in Medicare include:
 Duplicate submission of the same service or claim
 Payment to the incorrect payee
 Payment for excluded or medically-unnecessary services
 Payment for non-covered services

Before the Affordable Care Act, providers did not face explicit deadlines for returning taxpayers’ money. The Affordable Care Act requires a specific timeframe by which overpayments must be reported and returned. Any failure to report and return the overpayment within the applicable time frame could be a violation of the False Claims Act. Providers also could be subject to civil monetary penalties or excluded from participating in federal healthcare programs for failure to report and return an overpayment..

To read the proposed rule that would require providers and suppliers receiving funds under the Medicare program to report and return overpayments within specific timeframes, visit the Federal Register through this link

This change in format will allow those in SNF to attend, one, two or all three days, while those in Outpatient Rehab can attend one or two days, and those who work in Home Health can attend the Sunday program.

We are currently working on the rest of our schedule for 2012, presenting our first weekend in Tampa, FL on March 30th, 31st and May 1st. We will be finalizing the location by the end of this month.

Meanwhile, on January 1st, therapists will see some change in the reimbursement rates as there are increases to some of the practice expense values that were included in the 2012 Final Rule.

It is important that all therapists that treat Medicare Part B patients get involved in lobbying for these changes proposed by the House. This can be done by calling or e-mailing your representatives asking them to support this house bill. You can also call the Capitol switchboard and ask for your legislator’s office. Another avenue is to inform your patient’s of what is happening, the risk to them of having their benefits drastically reduced and therapy treatment above the cap being their cost completely; (hospital outpatient departments coming under the cap in 2012).

We here at Encompass want to thank those of you who attended our seminars during this past year, it was great to see many returnees. We are planning a slightly different 2012 with less on-site seminars and more live web based presentations. Based on the economy we believe that we can still provide the quality of our “in person” presentations with less cost for our attendees.

So in saying that, we wish you a blessed holiday season and a happy, healthy New Year.