Guest guest Posted December 15, 2011 Report Share Posted December 15, 2011 Hi Chad, I can answer your questions: First of all the change that hospital outpatient departments will no longer be exempt from the cap is NOT law yet and it far from being passed. It was in the House version of the bill which was passed. The Senate is working on their version, a compromise bill must be worked on and it must get past President Obama. The language in the House bill would remove the exemptions for hospitals - any type of hospital if you read the language but I cannot tell you 100% about a " Critical Access Hospital " . I would certainly recommend that your Administration start looking into how they would implement the Fee Schedule for outpatient Part B Medicare, though. Second, the Medicare cap is PER YEAR, period. Once the beneficiary has used up the cap, then a facility should be communicating with the beneficiary about their options. Currently our clinic does this at admission where the beneficiary is apprised of the cap, how much they have remaining on the cap (if they had therapy in the same calendar year already) and the options of: 1) continuing at our clinic and pay for it out of pocket. An Medicare ABN form would be signed for this situation; 2) stopping therapy and continuing a home program or 3) that they are referred to a hospital outpatient department. If the House bill language is passed as it is now, Option 3 will be eliminated and the beneficiaries will have just two options. And yes, the $1880 is combined PT and SLP. Our average has been between 12 and 15 visits covered. If they use that up and get a new diagnosis later in the year that is not on the exceptions list - too bad-no coverage. That is for only Medicare beneficiaries that fall under the cap. We are also hoping that the Exceptions process is continued. Medicare beneficiaries with certain diagnoses can continue to receive medically necessary care past the cap if they fall under the Exceptions process. There are extensive rules under the exceptions process that you will have to learn as well. If your facility does not have a process now, they should also make sure that they can handle cash based business as Medicare beneficiaries that fall under the cap and reach the cap limits will have to pay out of pocket to continue therapy. As long as communication is good, a few seniors will decide to pay so your facility will have to be prepared for that. As far as the MPPR - if you go to a Fee Schedule you will also have MPPR. As much as the hospital outpatient exemption was unfair to private practices, it was nice to have a safety valve for those patients that met their cap-that will all go away if the language in the House bill passes. Then we would have to rely on the Exceptions process which is also in danger of being changed with the new rules once billing reaches $3700. M.Howell, P.T., M.P.T. IPTA Payment Specialist Meridian, Idaho thowell@... This email and any files transmitted with it may contain PRIVILEGED or CONFIDENTIAL information and may be read or used only by the intended recipient. If you are not the intended recipient of the email or any of its attachments, please be advised that you have received this email in error and that any use, dissemination, distribution, forwarding, printing or copying of this email or any attached files is strictly prohibited. If you have received this email in error, please immediately purge it and all attachments and notify the sender by reply email. From: PTManager [mailto:PTManager ] On Behalf Of Chad Yoakam Sent: Thursday, December 15, 2011 4:05 PM To: PTManager Subject: Therapy cap Hello all! I just sat in on the APTA Audio conference earlier today on the coming Medicare changes for 2012. I need some clarification and would welcome comments from anyone who can help.... 1. I understand the therapy cap now applies to hospital out-patient settings. I am the manager of a Critical Access Hospital where we have out-patient clinics. We are not paid on the Physician Fee Schedule but, on a CMS formula for CAHs. The language used today makes me think that we are, indeed, subject to the cap. But, many of the things discussed today were in the context of those being paid under the fee schedule. Can anyone clarify whether CAHs are subject to the cap? 2. If we are subject to the cap at the new rate of $1,880.00 is the cap per year, per episode of therapy, per diagnosis, etc? I do understand that our government still has not fixed the PT & SLP lumped together problem. 3. In regards to the Multiple Procedure Payment Reduction Policy....again, are CAHs subject to this. My understanding is that hospital based out-patient clinics are subject to the 25% reduction under this policy for the 2nd and 3rd procedures (CPT codes) that we bill. However, it sounds like this may only be for hospitals being paid under the fee schedule. Can anyone clarify? I was in-line to ask these questions to Steve Levine at the end of the audio conference but, they wrapped up the Q & A right on time and I was unable to ask these questions. I've e-mailed the APTA and will post to the group with any response I get. Thanks in advance for your input. Merry Christmas & Happy New Year! Chad Chad Yoakam, MS, PT Manager of Rehabilitation Services Livingston HealthCare Office Fax This electronic message is intended only for the named recipient, and may contain information that is confidential or privileged. If you are not the intended recipient, you are hereby notified that any disclosure, copying, distribution or use of the contents of this message is strictly prohibited. If you have received this message in error or are not the named recipient, please notify us immediately by contacting the sender at the electronic mail address noted above, and delete and destroy all copies of this message. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 15, 2011 Report Share Posted December 15, 2011 Just to clarify, CMS eliminated the exception diagnoses' in July 2009. Once a patient meets the therapy cap dollar amount, you can use the KX modifier and that will allow payment above and beyond the therapy cap this year (2011). We hope the exception process will be there in 2012 and we are just waiting to see how the Senate and House can agree on a bill. Rick Gawenda, PT President Gawenda Seminars & Consulting, Inc. http://www.gawendaseminars.com On Dec 15, 2011, at 5:08 PM, " M. Howell PT, MPT " wrote: > Hi Chad, > > I can answer your questions: > > First of all the change that hospital outpatient departments will no longer > be exempt from the cap is NOT law yet and it far from being passed. It was > in the House version of the bill which was passed. The Senate is working on > their version, a compromise bill must be worked on and it must get past > President Obama. The language in the House bill would remove the exemptions > for hospitals - any type of hospital if you read the language but I cannot > tell you 100% about a " Critical Access Hospital " . I would certainly > recommend that your Administration start looking into how they would > implement the Fee Schedule for outpatient Part B Medicare, though. > > Second, the Medicare cap is PER YEAR, period. Once the beneficiary has used > up the cap, then a facility should be communicating with the beneficiary > about their options. Currently our clinic does this at admission where the > beneficiary is apprised of the cap, how much they have remaining on the cap > (if they had therapy in the same calendar year already) and the options of: > 1) continuing at our clinic and pay for it out of pocket. An Medicare ABN > form would be signed for this situation; 2) stopping therapy and continuing > a home program or 3) that they are referred to a hospital outpatient > department. If the House bill language is passed as it is now, Option 3 > will be eliminated and the beneficiaries will have just two options. And > yes, the $1880 is combined PT and SLP. Our average has been between 12 and > 15 visits covered. If they use that up and get a new diagnosis later in the > year that is not on the exceptions list - too bad-no coverage. That is for > only Medicare beneficiaries that fall under the cap. We are also hoping > that the Exceptions process is continued. Medicare beneficiaries with > certain diagnoses can continue to receive medically necessary care past the > cap if they fall under the Exceptions process. There are extensive rules > under the exceptions process that you will have to learn as well. > > If your facility does not have a process now, they should also make sure > that they can handle cash based business as Medicare beneficiaries that fall > under the cap and reach the cap limits will have to pay out of pocket to > continue therapy. As long as communication is good, a few seniors will > decide to pay so your facility will have to be prepared for that. > > As far as the MPPR - if you go to a Fee Schedule you will also have MPPR. > > As much as the hospital outpatient exemption was unfair to private > practices, it was nice to have a safety valve for those patients that met > their cap-that will all go away if the language in the House bill passes. > Then we would have to rely on the Exceptions process which is also in danger > of being changed with the new rules once billing reaches $3700. > > M.Howell, P.T., M.P.T. > > IPTA Payment Specialist > > Meridian, Idaho > > thowell@... > > This email and any files transmitted with it may contain PRIVILEGED or > CONFIDENTIAL information and may be read or used only by the intended > recipient. If you are not the intended recipient of the email or any of its > attachments, please be advised that you have received this email in error > and that any use, dissemination, distribution, forwarding, printing or > copying of this email or any attached files is strictly prohibited. If you > have received this email in error, please immediately purge it and all > attachments and notify the sender by reply email. > > From: PTManager [mailto:PTManager ] On Behalf > Of Chad Yoakam > Sent: Thursday, December 15, 2011 4:05 PM > To: PTManager > Subject: Therapy cap > > Hello all! > > I just sat in on the APTA Audio conference earlier today on the coming > Medicare changes for 2012. I need some clarification and would welcome > comments from anyone who can help.... > > 1. I understand the therapy cap now applies to hospital out-patient > settings. I am the manager of a Critical Access Hospital where we have > out-patient clinics. We are not paid on the Physician Fee Schedule but, > on a CMS formula for CAHs. The language used today makes me think that > we are, indeed, subject to the cap. But, many of the things discussed > today were in the context of those being paid under the fee schedule. > Can anyone clarify whether CAHs are subject to the cap? > > 2. If we are subject to the cap at the new rate of $1,880.00 is the > cap per year, per episode of therapy, per diagnosis, etc? I do > understand that our government still has not fixed the PT & SLP lumped > together problem. > > 3. In regards to the Multiple Procedure Payment Reduction > Policy....again, are CAHs subject to this. My understanding is that > hospital based out-patient clinics are subject to the 25% reduction > under this policy for the 2nd and 3rd procedures (CPT codes) that we > bill. However, it sounds like this may only be for hospitals being paid > under the fee schedule. Can anyone clarify? > > I was in-line to ask these questions to Steve Levine at the end of the > audio conference but, they wrapped up the Q & A right on time and I was > unable to ask these questions. I've e-mailed the APTA and will post to > the group with any response I get. Thanks in advance for your input. > > Merry Christmas & Happy New Year! > > Chad > > Chad Yoakam, MS, PT > > Manager of Rehabilitation Services > > Livingston HealthCare > > Office > > Fax > > This electronic message is intended only for the named recipient, and may > contain information that is confidential or privileged. If you are not the > intended recipient, you are hereby notified that any disclosure, copying, > distribution or use of the contents of this message is strictly prohibited. > If you have received this message in error or are not the named recipient, > please notify us immediately by contacting the sender at the electronic mail > address noted above, and delete and destroy all copies of this message. > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 15, 2011 Report Share Posted December 15, 2011 Thanks Rick – brain blip on my part M.Howell, P.T., M.P.T. IPTA Payment Specialist Meridian, Idaho thowell@... This email and any files transmitted with it may contain PRIVILEGED or CONFIDENTIAL information and may be read or used only by the intended recipient. If you are not the intended recipient of the email or any of its attachments, please be advised that you have received this email in error and that any use, dissemination, distribution, forwarding, printing or copying of this email or any attached files is strictly prohibited. If you have received this email in error, please immediately purge it and all attachments and notify the sender by reply email. From: PTManager [mailto:PTManager ] On Behalf Of Rick Gawenda Sent: Thursday, December 15, 2011 6:52 PM To: PTManager Subject: Re: Therapy cap Just to clarify, CMS eliminated the exception diagnoses' in July 2009. Once a patient meets the therapy cap dollar amount, you can use the KX modifier and that will allow payment above and beyond the therapy cap this year (2011). We hope the exception process will be there in 2012 and we are just waiting to see how the Senate and House can agree on a bill. Rick Gawenda, PT President Gawenda Seminars & Consulting, Inc. http://www.gawendaseminars.com On Dec 15, 2011, at 5:08 PM, " M. Howell PT, MPT " <thowell@... <mailto:thowell%40fiberpipe.net> > wrote: > Hi Chad, > > I can answer your questions: > > First of all the change that hospital outpatient departments will no longer > be exempt from the cap is NOT law yet and it far from being passed. It was > in the House version of the bill which was passed. The Senate is working on > their version, a compromise bill must be worked on and it must get past > President Obama. The language in the House bill would remove the exemptions > for hospitals - any type of hospital if you read the language but I cannot > tell you 100% about a " Critical Access Hospital " . I would certainly > recommend that your Administration start looking into how they would > implement the Fee Schedule for outpatient Part B Medicare, though. > > Second, the Medicare cap is PER YEAR, period. Once the beneficiary has used > up the cap, then a facility should be communicating with the beneficiary > about their options. Currently our clinic does this at admission where the > beneficiary is apprised of the cap, how much they have remaining on the cap > (if they had therapy in the same calendar year already) and the options of: > 1) continuing at our clinic and pay for it out of pocket. An Medicare ABN > form would be signed for this situation; 2) stopping therapy and continuing > a home program or 3) that they are referred to a hospital outpatient > department. If the House bill language is passed as it is now, Option 3 > will be eliminated and the beneficiaries will have just two options. And > yes, the $1880 is combined PT and SLP. Our average has been between 12 and > 15 visits covered. If they use that up and get a new diagnosis later in the > year that is not on the exceptions list - too bad-no coverage. That is for > only Medicare beneficiaries that fall under the cap. We are also hoping > that the Exceptions process is continued. Medicare beneficiaries with > certain diagnoses can continue to receive medically necessary care past the > cap if they fall under the Exceptions process. There are extensive rules > under the exceptions process that you will have to learn as well. > > If your facility does not have a process now, they should also make sure > that they can handle cash based business as Medicare beneficiaries that fall > under the cap and reach the cap limits will have to pay out of pocket to > continue therapy. As long as communication is good, a few seniors will > decide to pay so your facility will have to be prepared for that. > > As far as the MPPR - if you go to a Fee Schedule you will also have MPPR. > > As much as the hospital outpatient exemption was unfair to private > practices, it was nice to have a safety valve for those patients that met > their cap-that will all go away if the language in the House bill passes. > Then we would have to rely on the Exceptions process which is also in danger > of being changed with the new rules once billing reaches $3700. > > M.Howell, P.T., M.P.T. > > IPTA Payment Specialist > > Meridian, Idaho > > <mailto:thowell@... <mailto:thowell%40fiberpipe.net> > thowell@... <mailto:thowell%40fiberpipe.net> > > This email and any files transmitted with it may contain PRIVILEGED or > CONFIDENTIAL information and may be read or used only by the intended > recipient. If you are not the intended recipient of the email or any of its > attachments, please be advised that you have received this email in error > and that any use, dissemination, distribution, forwarding, printing or > copying of this email or any attached files is strictly prohibited. If you > have received this email in error, please immediately purge it and all > attachments and notify the sender by reply email. > > From: PTManager <mailto:PTManager%40yahoogroups.com> [mailto:PTManager <mailto:PTManager%40yahoogroups.com> ] On Behalf > Of Chad Yoakam > Sent: Thursday, December 15, 2011 4:05 PM > To: PTManager <mailto:PTManager%40yahoogroups.com> > Subject: Therapy cap > > Hello all! > > I just sat in on the APTA Audio conference earlier today on the coming > Medicare changes for 2012. I need some clarification and would welcome > comments from anyone who can help.... > > 1. I understand the therapy cap now applies to hospital out-patient > settings. I am the manager of a Critical Access Hospital where we have > out-patient clinics. We are not paid on the Physician Fee Schedule but, > on a CMS formula for CAHs. The language used today makes me think that > we are, indeed, subject to the cap. But, many of the things discussed > today were in the context of those being paid under the fee schedule. > Can anyone clarify whether CAHs are subject to the cap? > > 2. If we are subject to the cap at the new rate of $1,880.00 is the > cap per year, per episode of therapy, per diagnosis, etc? I do > understand that our government still has not fixed the PT & SLP lumped > together problem. > > 3. In regards to the Multiple Procedure Payment Reduction > Policy....again, are CAHs subject to this. My understanding is that > hospital based out-patient clinics are subject to the 25% reduction > under this policy for the 2nd and 3rd procedures (CPT codes) that we > bill. However, it sounds like this may only be for hospitals being paid > under the fee schedule. Can anyone clarify? > > I was in-line to ask these questions to Steve Levine at the end of the > audio conference but, they wrapped up the Q & A right on time and I was > unable to ask these questions. I've e-mailed the APTA and will post to > the group with any response I get. Thanks in advance for your input. > > Merry Christmas & Happy New Year! > > Chad > > Chad Yoakam, MS, PT > > Manager of Rehabilitation Services > > Livingston HealthCare > > Office > > Fax > > This electronic message is intended only for the named recipient, and may > contain information that is confidential or privileged. If you are not the > intended recipient, you are hereby notified that any disclosure, copying, > distribution or use of the contents of this message is strictly prohibited. > If you have received this message in error or are not the named recipient, > please notify us immediately by contacting the sender at the electronic mail > address noted above, and delete and destroy all copies of this message. > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 15, 2011 Report Share Posted December 15, 2011 Thanks Rick – brain blip on my part M.Howell, P.T., M.P.T. IPTA Payment Specialist Meridian, Idaho thowell@... This email and any files transmitted with it may contain PRIVILEGED or CONFIDENTIAL information and may be read or used only by the intended recipient. If you are not the intended recipient of the email or any of its attachments, please be advised that you have received this email in error and that any use, dissemination, distribution, forwarding, printing or copying of this email or any attached files is strictly prohibited. If you have received this email in error, please immediately purge it and all attachments and notify the sender by reply email. From: PTManager [mailto:PTManager ] On Behalf Of Rick Gawenda Sent: Thursday, December 15, 2011 6:52 PM To: PTManager Subject: Re: Therapy cap Just to clarify, CMS eliminated the exception diagnoses' in July 2009. Once a patient meets the therapy cap dollar amount, you can use the KX modifier and that will allow payment above and beyond the therapy cap this year (2011). We hope the exception process will be there in 2012 and we are just waiting to see how the Senate and House can agree on a bill. Rick Gawenda, PT President Gawenda Seminars & Consulting, Inc. http://www.gawendaseminars.com On Dec 15, 2011, at 5:08 PM, " M. Howell PT, MPT " <thowell@... <mailto:thowell%40fiberpipe.net> > wrote: > Hi Chad, > > I can answer your questions: > > First of all the change that hospital outpatient departments will no longer > be exempt from the cap is NOT law yet and it far from being passed. It was > in the House version of the bill which was passed. The Senate is working on > their version, a compromise bill must be worked on and it must get past > President Obama. The language in the House bill would remove the exemptions > for hospitals - any type of hospital if you read the language but I cannot > tell you 100% about a " Critical Access Hospital " . I would certainly > recommend that your Administration start looking into how they would > implement the Fee Schedule for outpatient Part B Medicare, though. > > Second, the Medicare cap is PER YEAR, period. Once the beneficiary has used > up the cap, then a facility should be communicating with the beneficiary > about their options. Currently our clinic does this at admission where the > beneficiary is apprised of the cap, how much they have remaining on the cap > (if they had therapy in the same calendar year already) and the options of: > 1) continuing at our clinic and pay for it out of pocket. An Medicare ABN > form would be signed for this situation; 2) stopping therapy and continuing > a home program or 3) that they are referred to a hospital outpatient > department. If the House bill language is passed as it is now, Option 3 > will be eliminated and the beneficiaries will have just two options. And > yes, the $1880 is combined PT and SLP. Our average has been between 12 and > 15 visits covered. If they use that up and get a new diagnosis later in the > year that is not on the exceptions list - too bad-no coverage. That is for > only Medicare beneficiaries that fall under the cap. We are also hoping > that the Exceptions process is continued. Medicare beneficiaries with > certain diagnoses can continue to receive medically necessary care past the > cap if they fall under the Exceptions process. There are extensive rules > under the exceptions process that you will have to learn as well. > > If your facility does not have a process now, they should also make sure > that they can handle cash based business as Medicare beneficiaries that fall > under the cap and reach the cap limits will have to pay out of pocket to > continue therapy. As long as communication is good, a few seniors will > decide to pay so your facility will have to be prepared for that. > > As far as the MPPR - if you go to a Fee Schedule you will also have MPPR. > > As much as the hospital outpatient exemption was unfair to private > practices, it was nice to have a safety valve for those patients that met > their cap-that will all go away if the language in the House bill passes. > Then we would have to rely on the Exceptions process which is also in danger > of being changed with the new rules once billing reaches $3700. > > M.Howell, P.T., M.P.T. > > IPTA Payment Specialist > > Meridian, Idaho > > <mailto:thowell@... <mailto:thowell%40fiberpipe.net> > thowell@... <mailto:thowell%40fiberpipe.net> > > This email and any files transmitted with it may contain PRIVILEGED or > CONFIDENTIAL information and may be read or used only by the intended > recipient. If you are not the intended recipient of the email or any of its > attachments, please be advised that you have received this email in error > and that any use, dissemination, distribution, forwarding, printing or > copying of this email or any attached files is strictly prohibited. If you > have received this email in error, please immediately purge it and all > attachments and notify the sender by reply email. > > From: PTManager <mailto:PTManager%40yahoogroups.com> [mailto:PTManager <mailto:PTManager%40yahoogroups.com> ] On Behalf > Of Chad Yoakam > Sent: Thursday, December 15, 2011 4:05 PM > To: PTManager <mailto:PTManager%40yahoogroups.com> > Subject: Therapy cap > > Hello all! > > I just sat in on the APTA Audio conference earlier today on the coming > Medicare changes for 2012. I need some clarification and would welcome > comments from anyone who can help.... > > 1. I understand the therapy cap now applies to hospital out-patient > settings. I am the manager of a Critical Access Hospital where we have > out-patient clinics. We are not paid on the Physician Fee Schedule but, > on a CMS formula for CAHs. The language used today makes me think that > we are, indeed, subject to the cap. But, many of the things discussed > today were in the context of those being paid under the fee schedule. > Can anyone clarify whether CAHs are subject to the cap? > > 2. If we are subject to the cap at the new rate of $1,880.00 is the > cap per year, per episode of therapy, per diagnosis, etc? I do > understand that our government still has not fixed the PT & SLP lumped > together problem. > > 3. In regards to the Multiple Procedure Payment Reduction > Policy....again, are CAHs subject to this. My understanding is that > hospital based out-patient clinics are subject to the 25% reduction > under this policy for the 2nd and 3rd procedures (CPT codes) that we > bill. However, it sounds like this may only be for hospitals being paid > under the fee schedule. Can anyone clarify? > > I was in-line to ask these questions to Steve Levine at the end of the > audio conference but, they wrapped up the Q & A right on time and I was > unable to ask these questions. I've e-mailed the APTA and will post to > the group with any response I get. Thanks in advance for your input. > > Merry Christmas & Happy New Year! > > Chad > > Chad Yoakam, MS, PT > > Manager of Rehabilitation Services > > Livingston HealthCare > > Office > > Fax > > This electronic message is intended only for the named recipient, and may > contain information that is confidential or privileged. If you are not the > intended recipient, you are hereby notified that any disclosure, copying, > distribution or use of the contents of this message is strictly prohibited. > If you have received this message in error or are not the named recipient, > please notify us immediately by contacting the sender at the electronic mail > address noted above, and delete and destroy all copies of this message. > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 16, 2011 Report Share Posted December 16, 2011 Chad, I am also the Director at a CAH, so I would be very interested in what you find out. Thanks! Gates, PT, MPT Ohio County Hospital sgates@... From: PTManager [mailto:PTManager ] On Behalf Of Chad Yoakam Sent: Thursday, December 15, 2011 5:05 PM To: PTManager Subject: Therapy cap Hello all! I just sat in on the APTA Audio conference earlier today on the coming Medicare changes for 2012. I need some clarification and would welcome comments from anyone who can help.... 1. I understand the therapy cap now applies to hospital out-patient settings. I am the manager of a Critical Access Hospital where we have out-patient clinics. We are not paid on the Physician Fee Schedule but, on a CMS formula for CAHs. The language used today makes me think that we are, indeed, subject to the cap. But, many of the things discussed today were in the context of those being paid under the fee schedule. Can anyone clarify whether CAHs are subject to the cap? 2. If we are subject to the cap at the new rate of $1,880.00 is the cap per year, per episode of therapy, per diagnosis, etc? I do understand that our government still has not fixed the PT & SLP lumped together problem. 3. In regards to the Multiple Procedure Payment Reduction Policy....again, are CAHs subject to this. My understanding is that hospital based out-patient clinics are subject to the 25% reduction under this policy for the 2nd and 3rd procedures (CPT codes) that we bill. However, it sounds like this may only be for hospitals being paid under the fee schedule. Can anyone clarify? I was in-line to ask these questions to Steve Levine at the end of the audio conference but, they wrapped up the Q & A right on time and I was unable to ask these questions. I've e-mailed the APTA and will post to the group with any response I get. Thanks in advance for your input. Merry Christmas & Happy New Year! Chad Chad Yoakam, MS, PT Manager of Rehabilitation Services Livingston HealthCare Office Fax This electronic message is intended only for the named recipient, and may contain information that is confidential or privileged. If you are not the intended recipient, you are hereby notified that any disclosure, copying, distribution or use of the contents of this message is strictly prohibited. If you have received this message in error or are not the named recipient, please notify us immediately by contacting the sender at the electronic mail address noted above, and delete and destroy all copies of this message. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 16, 2011 Report Share Posted December 16, 2011 Chad, I am also the Director at a CAH, so I would be very interested in what you find out. Thanks! Gates, PT, MPT Ohio County Hospital sgates@... From: PTManager [mailto:PTManager ] On Behalf Of Chad Yoakam Sent: Thursday, December 15, 2011 5:05 PM To: PTManager Subject: Therapy cap Hello all! I just sat in on the APTA Audio conference earlier today on the coming Medicare changes for 2012. I need some clarification and would welcome comments from anyone who can help.... 1. I understand the therapy cap now applies to hospital out-patient settings. I am the manager of a Critical Access Hospital where we have out-patient clinics. We are not paid on the Physician Fee Schedule but, on a CMS formula for CAHs. The language used today makes me think that we are, indeed, subject to the cap. But, many of the things discussed today were in the context of those being paid under the fee schedule. Can anyone clarify whether CAHs are subject to the cap? 2. If we are subject to the cap at the new rate of $1,880.00 is the cap per year, per episode of therapy, per diagnosis, etc? I do understand that our government still has not fixed the PT & SLP lumped together problem. 3. In regards to the Multiple Procedure Payment Reduction Policy....again, are CAHs subject to this. My understanding is that hospital based out-patient clinics are subject to the 25% reduction under this policy for the 2nd and 3rd procedures (CPT codes) that we bill. However, it sounds like this may only be for hospitals being paid under the fee schedule. Can anyone clarify? I was in-line to ask these questions to Steve Levine at the end of the audio conference but, they wrapped up the Q & A right on time and I was unable to ask these questions. I've e-mailed the APTA and will post to the group with any response I get. Thanks in advance for your input. Merry Christmas & Happy New Year! Chad Chad Yoakam, MS, PT Manager of Rehabilitation Services Livingston HealthCare Office Fax This electronic message is intended only for the named recipient, and may contain information that is confidential or privileged. If you are not the intended recipient, you are hereby notified that any disclosure, copying, distribution or use of the contents of this message is strictly prohibited. If you have received this message in error or are not the named recipient, please notify us immediately by contacting the sender at the electronic mail address noted above, and delete and destroy all copies of this message. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 17, 2011 Report Share Posted December 17, 2011 A question then for you Rick: The initial poster of this thread led me to believe that he was talking about outpatient PT being done in the CAH setting. How could they be doing that under Medicare without being on the Fee Schedule? I thought all outpatient PT under Medicare was being done under the Fee Schedule? Guess I need clarification on this one M.Howell, P.T., M.P.T. IPTA Payment Specialist Meridian, Idaho thowell@... This email and any files transmitted with it may contain PRIVILEGED or CONFIDENTIAL information and may be read or used only by the intended recipient. If you are not the intended recipient of the email or any of its attachments, please be advised that you have received this email in error and that any use, dissemination, distribution, forwarding, printing or copying of this email or any attached files is strictly prohibited. If you have received this email in error, please immediately purge it and all attachments and notify the sender by reply email. From: PTManager [mailto:PTManager ] On Behalf Of Rick Gawenda Sent: Saturday, December 17, 2011 9:23 AM To: PTManager Subject: Re: Therapy cap Please keep in mind that CAH's are not reimbursed under the Medicare Physician Fee Schedule (MPFS) so the MPPR policy does not apply in CAH's. CAH's are reimbursed on a cost basis. With that being said, if the therapy cap was applied to hospital settings, it would not apply to CAH's at this time since you are not reimbursed under the MPFS. We just have to wait and see how this process unfolds in the first 2 months of 2012. Rick Gawenda, PT President Gawenda Seminars & Consulting, Inc. www.gawendaseminars.com The Senate today passed a short term fix to several items, one of them being a halt to the scheduled 27.4% reduction in payment for services reimbursed under the Medicare Physician Fee Schedule through February 2012. This will set up the showdown between the House, Senate, and President when the House and Senate reconvene in January 2012. There was no mention of extending the therapy cap exception process in 2012 or application of the therapy cap to the hospital outpatient setting. http://news.yahoo.com/senate-oks-short-term-extension-payroll-tax-cut-144921264.\ html Stay tuned for updates. Rick Gawenda, PT President Gawenda Seminars & Consulting, Inc. www.gawendaseminars.com Follow Gawenda Seminars & Consulting, Inc on Facebook Register for January 24, 2012 audio conference " 2012 Medicare & Private Payor Updates " at https://www.showmyevent.com/events/viewEventDetails.aspx?EventID=1735 From: Chad Yoakam <chad.yoakam@... <mailto:chad.yoakam%40livingstonhealthcare.org> > Subject: Therapy cap To: PTManager <mailto:PTManager%40yahoogroups.com> Date: Thursday, December 15, 2011, 6:04 PM Hello all! I just sat in on the APTA Audio conference earlier today on the coming Medicare changes for 2012. I need some clarification and would welcome comments from anyone who can help.... 1. I understand the therapy cap now applies to hospital out-patient settings. I am the manager of a Critical Access Hospital where we have out-patient clinics. We are not paid on the Physician Fee Schedule but, on a CMS formula for CAHs. The language used today makes me think that we are, indeed, subject to the cap. But, many of the things discussed today were in the context of those being paid under the fee schedule. Can anyone clarify whether CAHs are subject to the cap? 2. If we are subject to the cap at the new rate of $1,880.00 is the cap per year, per episode of therapy, per diagnosis, etc? I do understand that our government still has not fixed the PT & SLP lumped together problem. 3. In regards to the Multiple Procedure Payment Reduction Policy....again, are CAHs subject to this. My understanding is that hospital based out-patient clinics are subject to the 25% reduction under this policy for the 2nd and 3rd procedures (CPT codes) that we bill. However, it sounds like this may only be for hospitals being paid under the fee schedule. Can anyone clarify? I was in-line to ask these questions to Steve Levine at the end of the audio conference but, they wrapped up the Q & A right on time and I was unable to ask these questions. I've e-mailed the APTA and will post to the group with any response I get. Thanks in advance for your input. Merry Christmas & Happy New Year! Chad Chad Yoakam, MS, PT Manager of Rehabilitation Services Livingston HealthCare Office Fax This electronic message is intended only for the named recipient, and may contain information that is confidential or privileged. If you are not the intended recipient, you are hereby notified that any disclosure, copying, distribution or use of the contents of this message is strictly prohibited. If you have received this message in error or are not the named recipient, please notify us immediately by contacting the sender at the electronic mail address noted above, and delete and destroy all copies of this message. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 17, 2011 Report Share Posted December 17, 2011 CAH's are paid on a reasonable cost basis, not the MPFS. I have pasted the language below from CMS Pub 100-04, Chapter 5, Section. I have also pasted the link to the manual for you and others. The MPFS does not apply to outpatient rehabilitation services furnished by critical access hospitals (CAHs). CAHs are to be paid on a reasonable cost basis. http://www.cms.gov/manuals/downloads/clm104c05.pdf Rick Gawenda, PT President Gawenda Seminars & Consulting, Inc. www.gawendaseminars.com From: Chad Yoakam <chad.yoakam@... <mailto:chad.yoakam%40livingstonhealthcare.org> > Subject: Therapy cap To: PTManager <mailto:PTManager%40yahoogroups.com> Date: Thursday, December 15, 2011, 6:04 PM Hello all! I just sat in on the APTA Audio conference earlier today on the coming Medicare changes for 2012. I need some clarification and would welcome comments from anyone who can help.... 1. I understand the therapy cap now applies to hospital out-patient settings. I am the manager of a Critical Access Hospital where we have out-patient clinics. We are not paid on the Physician Fee Schedule but, on a CMS formula for CAHs. The language used today makes me think that we are, indeed, subject to the cap. But, many of the things discussed today were in the context of those being paid under the fee schedule. Can anyone clarify whether CAHs are subject to the cap? 2. If we are subject to the cap at the new rate of $1,880.00 is the cap per year, per episode of therapy, per diagnosis, etc? I do understand that our government still has not fixed the PT & SLP lumped together problem. 3. In regards to the Multiple Procedure Payment Reduction Policy....again, are CAHs subject to this. My understanding is that hospital based out-patient clinics are subject to the 25% reduction under this policy for the 2nd and 3rd procedures (CPT codes) that we bill. However, it sounds like this may only be for hospitals being paid under the fee schedule. Can anyone clarify? I was in-line to ask these questions to Steve Levine at the end of the audio conference but, they wrapped up the Q & A right on time and I was unable to ask these questions. I've e-mailed the APTA and will post to the group with any response I get. Thanks in advance for your input. Merry Christmas & Happy New Year! Chad Chad Yoakam, MS, PT Manager of Rehabilitation Services Livingston HealthCare Office Fax This electronic message is intended only for the named recipient, and may contain information that is confidential or privileged. If you are not the intended recipient, you are hereby notified that any disclosure, copying, distribution or use of the contents of this message is strictly prohibited. If you have received this message in error or are not the named recipient, please notify us immediately by contacting the sender at the electronic mail address noted above, and delete and destroy all copies of this message. Quote Link to comment Share on other sites More sharing options...
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