APTA

Registration for 2008 PPS Annual Conference & Exhibition -- Early Bird Registration Deadline July 28

Congress Overrides Presidential Veto - Medicare Improvements for Patients and Providers Act HR6331 becomes Law

The United States House of Representatives and the Senate voted to override the Presidential veto to pass HR 6331 - the Medicare Improvements for Patients and Providers Act. HR 6331 includes critical provisions for physical therapists and their patients, including legislation to avoid the 10.6% cut in payments under the Medicare physician fee schedule and the expiration of the therapy cap exceptions process.

The House passed this legislation by a 383-41 vote and by a 70-26 Senate vote. A two-thirds vote was needed by the House and the Senate to override the Presidential veto. Once the Senate voted to approve HR 6331, it now becomes law immediately. More details.

Did You Know that with the enactment of the Medicare Improvements for Patients and Providers Act of 2008 you have some options?

If you held your Medicare claims through for dates of service for July 1st -15th you:

May submit those claims with the Therapy Cap by-pass modifier (KX) if there is documented evidence that your patient requires intervention exceeding the $1810 cap
May submit those claims and expect to be reimbursed for covered services at the pre-July 1 rate (Jan-June 30 physician fee schedule)

If you submitted your Medicare claims for dates of service for July 1st -15th prior to July 16th you:

Should expect payment from Medicare at the 10.6% reduced fee schedule for those dates of service. Medicare will automatically start to reimburse the difference between the two fee schedules within the next few weeks providing you billed at your usual and customary (higher than Medicare rates) or minimally at the January-June 30th allowable rate. If you billed Medicare at the 10.6% reduced level you will need to contact your Medicare contractor regarding payment eligibility (per statute, Medicare pays at the Medicare allowable rate or the billed rate, whichever is less).
Should re-instate any Therapy Cap Exceptions patients and refund any monies collected from patients or alternative payors if the patient was eligible for the Therapy cap.

The Centers for Medicare and Medicaid Services (CMS) extended the therapy plan of care recertification period from 30 days to 90 days for Medicare beneficiaries seen on or after January 1, 2008. A physician or non-physician practitioner (if it is within his or her scope of practice) must certify the plan of care. Certification requires a dated signature on the plan of care or some other document that indicates approval of the plan of care. The therapist should forward the plan to the physician/NPP as soon as it is established to obtain certification (dated signature). This needs to be signed within the first 30 days after the initial therapy treatment session. The plan of care must be reviewed and recertified by the physician/NPP at least every 90 days. The therapist or physician could specify a
shorter time frame. The 90 day (cert) period begins on the date of the initial therapy treatment session.

Practice Application:
Physical therapist develops initial plan of care (POC) for 6 weeks, the POC would need to be re-certified at 6 weeks. Therapists need to utilize clinical judgement to determine the appropriate duration and frequency for care. Through this CMS change therapist’s have up to 90 days to complete the initial POC and recertify additional care.

PPS has many opportunities for you to share your expertise and network. For an application and more details click here.

Attention PT Students - Essay Contest deadline is August 20, 2008.

The Private Practice Section is sponsoring an essay contest for student PTs who are less than one year from graduation. Two students will be selected to receive complimentary registration and travel expenses to attend the PPS Annual Conference and Exposition in Orlando, Florida, from November 5-8, 2008.

Considering purchasing a new elctronic management system for your practice? The April 2007 and 2008 issues of Impact magazine feature this very topic. Click here to view these issues and gain more insight!