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September 13, 2011

Rehabilitation & Therapy Services

Overview

Inpatient Rehabilitation & Therapy Services

December 7, 2008

Medical rehabilitation focuses on improving or restoring functional independence for individuals with disabilities resulting from injury, illness or a medical condition.

Medical rehabilitation is provided at all levels of the health care continuum, including general acute-care hospitals, inpatient rehabilitation facilities (IRFs), skilled-nursing facilities, long-term-care hospitals, outpatient programs and home health agencies.

CHA News Article

CMS Posts IRF Rate Setting Files

May 15, 2013 Patricia Blaisdell Alyssa Keefe

The Centers for Medicare & Medicaid Services (CMS) has posted to its website the rate setting files for the inpatient rehabilitation facility (IRF) prospective payment system proposed rule for federal fiscal year 2014. The files, which include average length of stay for case mix groups, are available at
www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/InpatientRehabFacPPS/Data-Files.html.

CHA News Article

CMS Provides FAQs on Therapy Caps and ABNs

May 6, 2013 Patricia Blaisdell

The Centers for Medicare & Medicaid Services (CMS) has created a list of FAQs concerning therapy caps and use of the advance beneficiary notice of non-coverage (ABN). The FAQs address the requirements under the American Taxpayer Relief Act of 2012 for therapists to issue ABNs for services that are not medically necessary. A copy of the FAQs is attached.

CHA News Article

CMS Issues IRF PPS Proposed Rule for FFY 2014

May 3, 2013 Patricia Blaisdell Alyssa Keefe

The Centers for Medicare & Medicaid Services (CMS) has issued the proposed rule for the inpatient rehabilitation facility (IRF) prospective payment system (PPS) for federal fiscal year (FFY) 2014. Overall, CMS estimates that payments to IRFs will increase 2 percent, or approximately $150 million. The new rates will apply to services furnished to Medicare beneficiaries during FFY 2014, beginning with discharges on or after Oct. 1, 2013. CMS also proposes to remove a number of diagnosis codes from the list used to determine a facility’s presumptive compliance with the “60 percent rule.” In addition, the proposed rule includes three new measures for the quality reporting program: 1) Percentage of patients who were assessed and appropriately given the seasonal influenza vaccine; 2) Influenza vaccination coverage among health care personnel; and 3) An all-cause unplanned readmission measure for 30 days post discharge. Revisions to the IRF patient assessment instrument (IRF-PAI) to reflect new quality measure reporting requirements are also proposed. CHA will issue a more detailed summary, including facility-specific DataSuite reports, of the proposed rule in the coming weeks. CHA will also work with members to develop comments, which are due by July 1. The proposed rule is attached and will appear in the May 8 Federal Register.
 

CHA News Article

CMS Releases Latest PEPPER Data

April 1, 2013 Patricia Blaisdell

The Centers for Medicare & Medicaid Services (CMS) has announced availability of the newest Program for Evaluating Payment Patterns Electronic Report (PEPPER), with statistics through September 2012. PEPPER summarizes provider-specific data statistics for Medicare services that may be at risk for improper payments, helping to support providers’ internal auditing and monitoring activities. Visit www.pepperresources.org for information on using the reports, including recorded web-based training sessions, sample PEPPERs, user guides and FAQs.

CHA News Article

RACs to Review Therapy Claims
OP therapy services webinar offers update on new RAC role

March 22, 2013 Patricia Blaisdell Alyssa Keefe

The Centers for Medicare & Medicaid Services (CMS) has announced that, effective April 1, recovery audit contractors (RACs) will conduct prepayment reviews for Part B physical therapy, occupational therapy, and speech/language pathology services above the $3,700 threshold. Manual medical review of all therapy services above this threshold is required by the American Taxpayer Relief Act of 2012. In California, RACs will conduct the mandated reviews on a pre-payment basis.When claims for therapy services exceeding $3,700 are submitted, providers will receive an additional development request from the Medicare administrative contractor (MAC) unless an alternative process has been established. The RAC will conduct the prepayment review within 10 days of receiving the additional documentation and will notify the MAC of the payment decision. CHA will host a webinar March 27 from 10 a.m. – noon (PT) to provide practical advice and direction on how to implement the new regulations, including claims processing and denial management.

CHA News Article

CMS Issues Additional Information on Therapy Cap Manual Medical Review

March 1, 2013 Patricia Blaisdell

The Centers for Medicare & Medicaid Services (CMS) has issued information outlining the interim process for manual medical review for claims for therapy services that exceed the $3,700 threshold. The American Taxpayer Relief Act of 2012 extended the manual medical review process for claims exceeding $3,700 for physical therapy and speech/language pathology services, and/or $3,700 for occupational therapy services per beneficiary per year. CMS notes it is developing a long-term strategy to deal with manual medical reviews. In the interim, Medicare Administrative Contractors (MACs) will conduct pre-payment reviews for claims above the threshold. CMS has requested that MACs conduct the reviews within 10 days. At this time, there is no process in place for an advance request of an exception. For additional information, visit the CMS website at www.cms.gov/research-statistics-data-and-systems/monitoring-programs/medical-review/therapycap.html.

CHA News Article

CMS Issues Guidance on Therapy MPPR

February 27, 2013 Patricia Blaisdell

The Centers for Medicare & Medicaid Services (CMS) has issued guidance regarding the multiple procedure payment reduction (MPPR) for Medicare Part B physical therapy, occupational therapy, and speech and language pathology services. Beginning January 1, 2011, Part B therapy services provided in institutional settings were subject to a 25 percent MPPR, applied to the practice expense portion of the associated payment. The American Taxpayers Relief Act of 2012 increased the MPPR to 50 percent effective April 1, 2013. A copy of the CMS transmittal is attached.

CHA News Article

CMS Revises IRF Claims Processing Manual

January 24, 2013 Patricia Blaisdell Alyssa Keefe

The Centers for Medicare & Medicaid Services (CMS) has revised the inpatient rehabilitation facility section of the Medicare claims processing manual (Chapter 3, Section 140 of Pub. 100-04). According to CMS, the manual has been updated to reflect regulatory changes that are in effect, streamline language and improve readability. For details on the changes, see attached change request.

CHA News Article

ATRA Extends Therapy Cap Implementation

January 7, 2013 Patricia Blaisdell Alyssa Keefe

The American Taxpayer Relief Act (ATRA) of 2012, signed into law by President Obama last week, extends several provisions of the Middle Class Tax Relief and Job Creation Act of 2012 that impact therapy services provided by hospital outpatient departments (HOPDs). The ATRA effectively extends applying therapy caps to HOPDs through Dec. 31, 2013. Mandatory manual medical review for Part B therapy services, which became effective Oct. 1, 2012, for hospital and non-hospital therapy providers, is also extended through Dec. 31, 2013, as a result of the new law. 

CHA News Article

CMS Changes IRF Attestation Requirements

December 19, 2012 Patricia Blaisdell

The Centers for Medicare & Medicaid Services (CMS) has notified state survey agencies about new attestation statement requirements for inpatient rehabilitation facilities (IRFs). Each year IRFs must submit an attestation statement, using CMS form 437A or 437B, to verify they meet exclusion requirements from the inpatient prospective payment system (IPPS) and may be reimbursed under the IRF PPS system. Each attestation form must now include additional information from the IRF’s medical director, who must also cosign the form. Previously, only the hospital administrator or CEO was required to sign the attestation. For more information about the requirements, see attached CMS memorandum, revised attestation forms and associated worksheets.

CHA News Article

CHA Issues Summary of IRF QRP Provisions

December 7, 2012 Patricia Blaisdell Alyssa Keefe

CHA has released a summary of provisions related to the inpatient rehabilitation facility (IRF) quality reporting program (QRP)  that are included in the recently released Medicare outpatient prospective payment system final rule. In the final rule, CMS describes the update process for quality measures and finalizes its proposal to retain all IRF QRP measures for federal fiscal years 2014 and 2015. For more information, see attached CHA summary.

CHA News Article

CMS to Host Call on New Part B Functional Reporting

November 29, 2012 Patricia Blaisdell

The Centers for Medicare & Medicaid Services (CMS) will host a conference call Dec. 12 on the new functional reporting requirements for outpatient therapy services that go into effect Jan. 1, 2013. The call will explain how to use the 42 new nonpayable functional G-codes and seven new severity/complexity modifiers on claims for Medicare Part B physical therapy, occupational therapy and speech language pathology services. CMS will also cover associated requirements for documenting medical records. In addition, participants will have an opportunity to ask questions. For more information and to register, go to www.eventsvc.com/blhtechnologies.

CHA News Article

IRF, LTCH Quality Program Recordings Available

July 27, 2012 Patricia Blaisdell Alyssa Keefe

Recordings of recent conference calls held by the Centers for Medicare & Medicaid Services on the quality reporting programs for inpatient rehabilitation facilities (IRFs) and long-term-care hospitals (LTCHs) will be available July 30 through Aug. 1. Facilities may access the calls by dialing (855) 859-2056, and using conference IDs 13189170 for IRFs and 13198135 for LTCHs. As mandated by the Affordable Care Act, IRF and LTCH quality reporting programs will begin Oct. 1. 

CHA News Article

CMS Schedules Calls on IRF Quality Program

July 17, 2012 Patricia Blaisdell Alyssa Keefe

The Centers for Medicare & Medicaid Services (CMS) will host a series of monthly Open Door Forum (ODF) calls for the upcoming implementation of the inpatient rehabilitation facility quality reporting program. The calls will be held from 10 a.m. to 11:30 a.m. (PT) July 26, Aug. 16, Sept. 20 and Oct. 18, and will include presentations on various topics with opportunities for questions and answers. Providers may submit topic suggestions to IRF.questions@CMS.hhs.gov. For more information, go to www.cms.gov/Outreach-and-Education/Outreach/OpenDoorForums/index.html.

CHA News Article

CMS Issues IRF Quality Program Proposed Rule

July 17, 2012 Patricia Blaisdell Alyssa Keefe

The Centers for Medicare & Medicaid Services (CMS) has issued a proposed rule regarding the inpatient rehabilitation facility (IRF) quality reporting program (QRP). The proposed rule was included in the calendar year 2013 hospital outpatient prospective payment system (OPPS) proposed rule issued July 6. CHA’s “first-glance” summary of the OPPS and IRF QRP proposed rules is available at www.calhospital.org/cy2013-opps-proposed-first-glance. In the coming weeks, CHA will issue a more detailed summary of the proposed rule, and will work with members to develop comments for submission to CMS. Comments are due Sept. 4 at 2 p.m. (PT). 

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