RE: Request input CMS policy please

[Guest guest]

wow - you made it on!

________________________________

From: PTManager [mailto:PTManager ] On

Behalf Of Larry Benz

Sent: Tuesday, December 23, 2008 9:41 AM

To: PTManager

Subject: Request input CMS policy please

I recently was informed that I am on the STATS Policy Workgroup

nominated by several colleagues. STATS is the Short Term Alternatives

for Therapy Services (STATS) contract by the Centers for Medicare and

Medicaid Services (CMS) to perform follow-on claims analysis and to work

with outpatient therapy stakeholders to develop recommendations for

improving outpatient therapy payment policy in the short-term. There are

2 workgroups-Policy and Clinical. There are several PT's, OT's, and SLP

in the workgroups.

The mission of the STATS Policy Workgroup is as follows:

- Evaluate existing payment policy (not limited to existing outpatient

therapy policy).

- Identify specific policy applications that could reduce barriers to

the efficient/effective delivery of medically necessary services.

- Identify specific policy applications to increase confidence that

medically necessary services are being delivered.

The project is roughly 2 years and is very committed to not only

productive dialogue but transparency as well. I have received permission

to publish this and to seek suggestions and recommendations directly by

you and I assure you that these suggestions once consolidated will be

forwarded as appropriate.

Per the director of the STATS workgroup, a chief constraint of our

activities will be to discuss policy options that are realistically

achievable in the short-term. For example, some changes in Medicare

Manual language and some coding changes, if appropriate, can be achieved

in relative short periods, while complex changes to CMS payment systems

or forms may take extended periods of time. We are not seeking to

develop a new instrument or to validate an existing tool as other CMS

contracts serve those longer-term analyses. However, among several

options, we are considering if it is feasible that existing processes

being used by clinicians could be used in a new short-term policy to

help describe clinical need and/or progress on the claim form through

the introduction of new codes that could serve to describe clinical

information (e.g. severity, progress, or outcome). The proposed

introduction of such information may have policy implications within the

scope of CMS activiti es (e.g. Medicare Manual language and regulations)

to those beyond the direct scope of CMS control (e.g. Social Security

Act or CPT-4 and ICD-9 coding development). This workgroup will help

inform CSC of policy variables to consider, as well as policy barriers

that need to be addressed in order for proposed options to be considered

viable.

Time constraints may be the largest barriers to some potentially good

suggestions. As the project proceeds, it will begin to focus in on the

most realistic options and begin to address the details of what would

need to be addressed for those option(s) to be realized.

Here is your assignment! Prior to Jan 4, please comment directly on this

blog or to me at larry@...

<mailto:larry%40physicaltherapist.com>

<mailto:larry@...

<mailto:larry%40physicaltherapist.com> > the following:

What are the top 5 most achievable short term policy options that help

better identify patient need for therapy and/or measure

progress/outcome?

Your feedback and input is greatly appreciated.

Happy Holidays!

larry@... <mailto:larry%40physicaltherapist.com>

<mailto:larry@...

<mailto:larry%40physicaltherapist.com> >

__________________________________________

Larry

Larry Benz PT, DPT

PT Development LLC

13000 Equity Place Suite 105

Louisville, KY 40223

larry@... <mailto:larry%40physicaltherapist.com>

<mailto:larry@...

<mailto:larry%40physicaltherapist.com> >

mobile (Spinvox converts voice to email)

office (if you get voice mail-don't worry, it will Spinvox

and go to email)

(Fax. It will convert to email)

Follow PhysicalTherapy updates on

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<http://twitter.com/PhysicalTherapy> >

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rse-in-practice-management.html

<http://blog.myphysicaltherapyspace.com/2008/11/eim-executive-course-in-

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ram-presentation-762713/> >

CONFIDENTIALITY: This message is " Off The Record " . A lot of fancy legal

speak that none of us reads or understands if often contained here.

[Guest guest]

Larry,

Allow PT's to utilize the physician (office visit codes E & M levels of severity)

along with the intervention CPT codes per visit.? This would establish the level

of clinical need per viist.

Razza PT, DPT?

Request input CMS policy please

I recently was informed that I am on the STATS Policy Workgroup nominated by

several colleagues. STATS is the Short Term Alternatives for Therapy Services

(STATS) contract by the Centers for Medicare and Medicaid Services (CMS) to

perform follow-on claims analysis and to work with outpatient therapy

stakeholders to develop recommendations for improving outpatient therapy payment

policy in the short-term. There are 2 workgroups-Policy and Clinical. There are

several PT's, OT's, and SLP in the workgroups.

The mission of the STATS Policy Workgroup is as follows:

- Evaluate existing payment policy (not limited to existing outpatient therapy

policy).

- Identify specific policy applications that could reduce barriers to the

efficient/effective delivery of medically necessary services.

- Identify specific policy applications to increase confidence that medically

necessary services are being delivered.

The project is roughly 2 years and is very committed to not only productive

dialogue but transparency as well. I have received permission to publish this

and to seek suggestions and recommendations directly by you and I assure you

that these suggestions once consolidated will be forwarded as appropriate.

Per the director of the STATS workgroup, a chief constraint of our activities

will be to discuss policy options that are realistically achievable in the

short-term. For example, some changes in Medicare Manual language and some

coding changes, if appropriate, can be achieved in relative short periods, while

complex changes to CMS payment systems or forms may take extended periods of

time. We are not seeking to develop a new instrument or to validate an existing

tool as other CMS contracts serve those longer-term analyses. However, among

several options, we are considering if it is feasible that existing processes

being used by clinicians could be used in a new short-term policy to help

describe clinical need and/or progress on the claim form through the

introduction of new codes that could serve to describe clinical information

(e.g. severity, progress, or outcome). The proposed introduction of such

information may have policy implications within the scope of CMS activities

(e.g. Medicare Manual language and regulations) to those beyond the direct scope

of CMS control (e.g. Social Security Act or CPT-4 and ICD-9 coding development).

This workgroup will help inform CSC of policy variables to consider, as well as

policy barriers that need to be addressed in order for proposed options to be

considered viable.

Time constraints may be the largest barriers to some potentially good

suggestions. As the project proceeds, it will begin to focus in on the most

realistic options and begin to address the details of what would need to be

addressed for those option(s) to be realized.

Here is your assignment! Prior to Jan 4, please comment directly on this blog or

to me at larry@... the

following:

What are the top 5 most achievable short term policy options that help better

identify patient need for therapy and/or measure progress/outcome?

Your feedback and input is greatly appreciated.

Happy Holidays!

larry@...

__________________________________________

Larry

Larry Benz PT, DPT

PT Development LLC

13000 Equity Place Suite 105

Louisville, KY 40223

larry@...

mobile (Spinvox converts voice to email)

office (if you get voice mail-don't worry, it will Spinvox and go

to email)

(Fax. It will convert to email)

Follow PhysicalTherapy updates on Twitter<http://twitter.com/PhysicalTherapy>

blog: EvidenceInMotion<http://blog.myphysicaltherapyspace.com/>

EIM Executive Management

Program<http://blog.myphysicaltherapyspace.com/2008/11/eim-executive-course-in-p\

ractice-management.html> and Orthopedic

Residency<http://www.slideshare.net/1008/evidence-in-motions-residency-pro\

gram-presentation-762713/>

CONFIDENTIALITY: This message is " Off The Record " . A lot of fancy legal speak

that none of us reads or understands if often contained here.