Check the Glossary of Legislative Terms & Issues for extensive information about legislative issues facing hand therapists.
December 5, 2013
Legislative Alert - Call for Action - Stop the Cap: Support Medicare Access to Rehabilitation
The final 2014 Medicare physician fee schedule rule released by the Centers for Medicare and Medicaid Services (CMS) sets the therapy cap amount on outpatient services at $1,920. In addition, the rule announces a 20.1% reduction in Medicare payment rates for OTs and PTs, physicians, and other health care professionals -- a cut linked to the flawed sustainable growth rate (SGR) formula being discussed in Congress.
The 20.1% reduction in the final rule is the conversion factor used to determine Medicare payment rates, a reduction generated by the flawed SGR formula. Since 2003, Congress has enacted legislation preventing the reduction every year. The president's budget calls for averting these cuts and finding a permanent solution to this problem. Congress is currently working to address an alternative payment method that would include permanent repeal of the SGR.
November 5, 2013
Legislative Alert - Call for Action - HR 713, the Medicare Access to Rehabilitation Act of 2013
(To amend title XVIII of the Social Security Act to repeal the Medicare outpatient rehabilitation therapy caps.)
HR 713 now has 138 sponsors. If your representatives are not on the list, we encourage you to make contact and urge them to sign on. If your representatives are already sponsors, please thank them for their support. Check the list of HR 713 sponsors.
October 30, 2013
Stop the Therapy Cap
The Medicare therapy cap exceptions process expires December 31, 2013. Without Congressional action, patients will be faced with a hard cap on outpatient therapy services in 2014.
The Therapy Cap Coalition, a group of almost 50 associations, organizations, patient and consumer groups, is working together to prevent a hard cap, but needs your help. Join the Thunderclap and write your members of Congress to stop the therapy cap. You can find organizational action alerts on the Stop the Medicare Therapy Cap Facebook page.
Don't let patients lose access to critical therapy services on January 1! Join us for the Stop the Therapy Cap campaign and forward the information to your friends, family and colleagues. The campaign ends November 4, 2013.
October 9, 2013
Health Insurance Portability and Accountability Act (HIPAA)
Final Rule – Key Provisions
January 17, 2013 the US Department of Health and Human Services (HHS) released the final omnibus ruling to strengthen the privacy and security protections which were established under the Health Insurance Portability and Accountability Act of 1966 (HIPAA). The compliance date for these new rules is September 23, 2013. Read more in our Glossary of Legislative Terms and Issues.
October 1, 2013
Processing and payment of Medicare claims will continue despite the government shut down.
Legislative Alert - Call for Action
August 12, 2013
HR 713, the Medicare Access to Rehabilitation Act of 2013 - Assistance Needed
This bill was introduced in February by Rep. Jim Gerlach [R-PA6]. The bill is presently in the House Ways and Means Committee. The bill has the bipartisan support of 116 representatives, 77 Democrats and 39 Republicans.
You can help move this bill forward by contacting your representative and urging them to sign on if they haven't or by thanking them if they have!
Legislative Alert - More on Functional Reporting
June 21, 2013
Earlier this week, CMS released further information about functional reporting.
We recommend you review their resource - Frequently Asked Questions for CMS Functional Reporting: PT, OT and SLP Services.
CMS has changed its position and now states there is no need to re-start reporting after July 1. The ASHT Legislative & Reimbursement Division stands by its recommendation to re-start patient recording to ensure coverage. This is especially important for those clinics that are still addressing problems with documention interfaces, staff compliance and IT issues.
Legislative Alert - Functional Reporting Starts July 1, 2013
June 19, 2013
The CMS trial period for fuctional reporting is near completion.
Beginning July 1, 2013 claims without the required G-codes and severity index modifiers will be returned unpaid.
Since this is the beginning of a new reporting period, all current patients must be reset as if they are "new". In other words, if you have been participating in the testing phase with your patients, you must "start over" with fuctional reporting codes on or after July 1, 2013.
Please visit our Glossary of Legislative Terms & Issues for up-to-date information on functional reporting.
Legislative Alert - Support Limits on OT Copays
June 5, 2013, Forwarded from ConnOTA and AOTA:
House Bill 6546, an act concerning co-payments for physical therapy services, which would put a limit on copayments for PT ($30 per visit), recently passed the State House of Representatives and is currently awaiting action in the State Senate. While ConnOTA supports the intents behind this important legislation, unfortunately, the bill as amended only applies to PT services and does not include OT. This creates an access problem for OT and an uneven playing field in which legislature will be creating a policy that arbitrarily favors one health profession over another equally qualified profession (OT). Read More
Legislative Alert - Functional Reporting
May 28, 2013
After July 1, 2013, Medicare will no longer accept claims that do not have the required functional data and G codes. If you have not yet taken action, you are running out of time to implement functional measures.
To assist you in implementing this initiative, we have assembled a comprehensive, detailed resource document which is included in our Glossary of Legislative Terms & Issues. Please refer to the entry for Functional Reporting. Read More
Legislative Alert - Michigan Proposal for De-Regulation of Occupational Therapy
March 29, 2013, Forwarded from MiOTA and AOTA:
As many of you are aware, in April of 2012, we were alerted by MiOTA's lobbyist to detrimental recommendations that directly impact the practice of Occupational Therapy in the state of Michigan.
A report was released by the Office of Regulatory Reinvention (ORR) recommending the de-regulation of 18 professions within the state of Michigan. Included on that list was a recommendation to DE-REGULATE OCCUPATIONAL THERAPY. Read More
Legislative Alert - Missouri House Insurance Committee Legislation Pending
February 7, 2013, Forwarded from AOTA:
Legislation that would limit co-payments for physical therapy services to the amount charged by primary care physicians is pending in the Missouri House Insurance Committee. The bill does not currently apply to occupational therapy services. The Missouri Occupational Therapy Association provided testimony at a hearing February 5 to advocate that the bill be amended to include occupational therapy. MOTA supports HB 30 with amendments.
We need your help in identifying AOTA and MOTA members who live in legislative districts of the House Insurance Committee members. It is possible that the committee will vote to approve the bill on the same day. The previous hearing was cancelled and the bill was referred to this committee.
View the full eblast (PDF) for a list of House Insurance Committee members and contact Diana Baldwin with MOTA at email@example.com or by cell phone at (573) 819-7472 if your legislator is listed.
Legislative Alert - Act Now to Stop the Cap
December 4, 2012 AOTA and APTA are urging action now to stop the Therapy Cap:
Legislative Alert - Medicare Therapy Cap
November 20, 2012
The annual Medicare Therapy cap for 2013 is $1,880 for combined physical therapy and speech services and $1,880 for occupational therapy services for all outpatient Medicare beneficiaries. Evaluations or reevaluations are accepted from the cap. Read more
Legislative Alert - PQRS Update: Avoid the Penalty
November 16, 2012
What is PQRS? The 2006 Tax Relief and Health Care Act (TRHCA) (P.L. 109-432) required the establishment of a physician quality-reporting program. Read more
Legislative Alert - Manual Medical Review
November 8, 2012
The Manual Medical Review is part of the Middle Class Tax Relief and Job Creation Act of 2012. It is a process by which therapy providers can get an exemption for Medicare patients who have exceeded their $3,700 yearly cap for OT (individually) and PT and SLP (combined). Read more
Tell Congress: Now is the Time to Repeal the Medicare Therapy Cap
December 9, 2013
For many years now, around this time, we've called on you to help fight back the looming cap on therapy services. Because of your response year in and year out, we've managed to spur action in Congress to avoid the cap from taking hold.
This year is different. This year, we have a chance to do more than extend the exceptions process; we have a chance to get rid of the cap once and for all. But we need your help.
Next week, committees in both the House and Senate will consider legislation to reform the Medicare Physician Fee Schedule (MPFS) and repeal the Sustainable Growth Rate (SGR). It is imperative that therapy cap repeal be included in the legislation.
As a trusted health professional and constituent, your voice is critical to the debate. Contacting your representatives is easy with AOTA's Legislative Action Center:
Now is the time: Please urge your members of Congress to support repealing the therapy cap in SGR reform legislation.
CMS Issues Interim Instructions for Manual Medical Review Process for 2013
February 21, 2013: Forwarded from APTA:
On February 21, the Centers for Medicare and Medicaid Services (CMS) issued interim guidance on how the manual medical review process will be implemented in 2013 for outpatient therapy claims that exceed $3,700.
From October 1, 2012, through December 31, 2012, CMS used a prior approval process at $3,700 under which providers would submit a request to their Medicare Administrative Contractors (MAC) for approval of up to 20 visits. With the request, providers would include information from the patients' medical record (eg, progress reports, daily notes, plan of care) to support the need for the additional visits.
For 2013, CMS has replaced the prior approval process with prepayment review, at least for the interim. Under prepayment review, when the patient reaches $3,700 in outpatient therapy services, the MAC will send the provider an additional development request (ADR) asking him or her to submit documentation so that the MAC can determine whether the services are medically necessary. Typically under Medicare, MACs have 60 days to make a determination. However, CMS has stated that with regard to the therapy cap manual medical review process, MACs must decide within 10 days of receipt of the documentation whether the services exceeding $3,700 will be paid.
CMS currently is working on a long-term strategy for the manual medical review process. However, in the interim, the agency will enforce prepayment review of outpatient therapy claims that exceed $3,700 with a 10-day turnaround time.
Physical therapists should consult their MACs' websites for specific information about submitting documentation in response to an ADR.
Update from AOTA: Manual Medical Review for Outpatient Therapy – CMS Guidance and Upcoming Open Door Forum
August 2, 2012 The Centers for Medicare & Medicaid Services (CMS) announced the details of its plan to conduct manual medical reviews for outpatient therapy claims over $3,700. The reviews will occur in phases, with the first phase beginning October 1, 2012. For preliminary implementation information, see CMS Therapy Cap Fact Sheet and Requests for Exceptions to the Therapy Threshold: Manual Medical Review Process (FAQs). CMS is also hosting an Open Door Forum (ODF) on this matter for providers Tuesday, August 7 from 2-3:30pm Eastern Time: (800) 603-1774, conference ID 16032541. Additional guidance from CMS is expected in the coming days. More detailed information from AOTA and APTA about the implications for occupational therapy is forthcoming.
ASHT has partnered with Gawenda Seminars & Consulting, Inc. to offer ASHT members substantial discounts on legislative webinars. Information will be circulated to members via eblast as new webinars are offered.
Payer Contracting and Pricing and Payment Trends for Outpatient Therapy Services
November 19, 2013, 1-2:30 p.m. ET
This course will describe contract terms that are dangerous and help identify the hidden meaning of some contract terms. The course will also present the various pricing models and the trends seen among national payers for outpatient services.
PQRS – Physician Quality Reporting System Webinar
December 11, 2013, 1-2:30 p.m. ET
This educational program will provide physical and occupational therapists in private practice with the latest reporting requirements of the PQRS program for calendar year 2014 for Medicare traditional beneficiaries. CMS has proposed significant changes to the 2014 program compared to previous years. Additionally, unsuccessful reporting in 2014 will cause providers to be reimbursed 2 percent less in 2016.
Can’t make the live session of these webinars? Register for the webinar, and email Gawenda Seminars after the webinar stating you were unable to call in and listen live. You will be sent a CD of the actual live presentation and handouts.
October 2012 2012 is shaping up to be an important year to vote, with implications for occupational therapists, depending on who controls Congress and who lives in the White House. And much needs to take place before the end of the year or significant cuts in reimbursement will occur. Read more
Proposed Cuts to Medicare Payments
August 2011 Hand therapy focuses on one of the most complex parts of the human anatomy, making it a highly specialized discipline requiring continuing education, and, often, advanced certification. But despite high demand for these unique practitioners, the field is not immune to the burden of declining reimbursements. Read more.
Questions? Contact firstname.lastname@example.org or call ASHT Member Services at 856-380-6856.