If Congress does not take action by March 14th on telehealth and cuts in the Physician Fee Schedule:

  • Telehealth Therapy Services under Medicare Part B WILL END on March 31st.
  • The full -2.83% reduction in the Physician Fee Schedule’s conversion factor will continue in 2025 and impact providers nationwide.

 

Help Reverse Medicare Part B Payment Cuts and Preserve Telehealth Access for Medicare Beneficiaries

On December 21, 2024, Congress passed the American Relief Act, 2025, extending telehealth services until March 31, 2025, but left out provider relief from the 2.83% cut in the Physician Fee Schedule Conversion Factor, which was effective January 1, 2025. Congress also continued government funding until March 14, 2025.  Without further Congressional action by March 14th, rehab therapists will no longer be able to serve their Medicare beneficiaries using telehealth services! It is imperative that Congress hears from their constituents that they must address provider relief and pass a permanent telehealth authority before March 14th! 

If Congress does not take action on telehealth and the cuts in the Physician Fee Schedule by March 14th:

  1. Therapists’ ability to use telehealth to deliver services under Medicare Part B will end on March 31st.
  2. The full -2.83% reduction in the Physician Fee Schedule’s Conversion Factor will continue for the rest of 2025 and impact providers across the country.    

We urge you to contact your Members of Congress NOW to tell them to pass provider relief legislation, such as the Medicare Patient Access and Practice Stabilization Act (H.R. 879) which will mitigate Medicare payment reductions for 2025 and to continue the telehealth authority.

We urge you to contact your Members of Congress NOW! Tell them to pass provider relief legislation to mitigate Medicare payment reductions for 2025 and continue the telehealth authority.

Click here to Take Action now.

Legislation has been introduced to postpone the 15% reimbursement cuts to PTA and OTA treatments. Please help us to support this bill.

Dear Partners and Friends,

Please take a few minutes to read the below message from NASL regarding the new legislation that has been introduced in the US House. We need everyone to support this bill in order to postpone the 15% reduction in reimbursement for Med B services provided by PTAs and OTAs. This cut is set to happen on 1/1/2022. If this legislation is passed, it will delay this cut until 1/1/2023. Additionally, this bill allows for rural and underserved areas to be exempt from these cuts once they are implemented.

As skilled nursing operators and professionals, I urge each of you to take a few minutes to read the letter, make any additional edits/comments, and submit it to your personal representative. Spending a few minutes of your time could result in a very positive impact for our patients, as well as our industry. Your action is extremely time-sensitive because if this bill does not have enough support, it will not move on.

From NASL: Click here to access the letter and the ability to submit directly to your representative.

The time for advocacy on this issue is now as there is not much time left on the legislative calendar for Congress to act before this policy is implemented on January 1, 2022. NASL has prepared a letter for you to email to your respective House members urging them to cosponsor the Stabilizing Medicare Access to Rehabilitation and Therapy (SMART) Act of 2021 (H.R.5536) and asking them to add the bipartisan legislation to any legislative packages moving before the end of the year.

Use the link above or visit https://app.govpredict.com/gr/m5bwzm-u to access and send this email in under two minutes.

Thank you for your time and effort to support this bill!

Sincerely,

Cassie Murray, President

 

Cassie Murray, OTR, MBA, QCP

President of HTS

Healthcare Therapy Services, Inc.

Blog by: Stacy Baker, OTR/L, RAC-CT, CHC, Proactive Medical Review

Following a year of little to no medical review and extensive government spending, most experts forecast reimbursement compliance audits ramping up in 2021. Multiple areas are ripe for potential scrutiny, including, but not limited to PDPM coding and supportive documentation, the proper use of SNF waivers, and appropriate access to and accounting for Provider Relief Funds. Get the facts and ensure readiness with these insights into the current audit environment and the medical review entities that may rain on providers in the months ahead. CMS suspended audits between March 30 and August 3 of 2020 in order to reduce provider strain during the COVID-19 pandemic. This year, however, audits are resuming in full swing.

  • Under the new Biden administration, many industry leaders and healthcare attorneys predict an uptick in audits and healthcare prosecutions with “both government initiated litigation and qui tam suits…set for continued growth in 2021” according to Georgia Ravitz et. al (i) With Xavier Becerra, a former prosecutor, appointed secretary of HHS, the government is poised to advance fraud prevention efforts.
  • False Claims Act (FCA) recoveries in FY2020 were $2.2 billion, down from $3.1 billion in 2019 and lower than any year since 2008 at a time when spending has escalated throughout the pandemic. Healthcare made up 85% of FCA recoveries in 2020 and that trend is likely to continue through both standard channels and a focus on new risk areas such as telehealth billing fraud. ii
  • Recovery Audit Contractors are now authorized to review for Medical Necessity and Documentation Requirements specific to the Patient Driven Payment Model (PDPM), and the OIG has added new focus to the Work Plan to identify program integrity risks associated with Medicare telehealth services during the pandemic.

Click here to continue reading this blog.

 

About Proactive Medical Review
HTS partners with Proactive Medical Review, a third party company who specializes in ensuring compliance with regulatory standards and promoting measurable care excellence. The team includes SNF experienced nurse, MDS, Health Facility Administrator, therapist and reimbursement specialists with experience serving in multi-site contract therapy operations, as corporate directors of quality, clinical program specialists, and Compliance Officers. Proactive is uniquely positioned to assist in managing the many changes and challenges facing providers partnered with HTS. Learn more about our commitment to compliance here.

Blog by Sherry Roberts, RN, Clinical Consultant, Proactive Medical Review

COVID-19 is an acute, sometimes severe, respiratory illness caused by a novel coronavirus SARS-CoV2. Person-to-person spread occurs through contact with infected secretions, mainly via contact with large respiratory droplets, but can also occur via contact with a surface contaminated by respiratory droplets. Nursing facilities face higher risk of transmission due to high population density creating difficulty in maintaining avoidance precautions. Significantly, residents of nursing homes are at high risk for more severe disease because of age and underlying medical disorders.

Clinical Presentation

People with COVID-19 may have few to no symptoms, although some become severely ill and die. Symptoms can include fever, cough, and shortness of breath. The exact incubation time is not certain with estimates ranging from 1 to 14 days. The risk of serious disease and death in COVID-19 cases increases with age. COVID-19 can cause Pneumonia and ARDS (Acute Respiratory Distress Syndrome), Severe Acute Respiratory Syndrome (SARS), Acute Respiratory Failure and several other conditions.

Respiratory Assessment

If COVID-19 disease is suspected as part of the screening process, a  thorough respiratory assessment is essential, including careful auscultation to identify residents with a risk of significant lower respiratory illness.

Click here to continue reading this blog.

Southfield Village Therapy Team Celebrates a Successful Recovery!

Patient, Brenda, enjoyed therapy so much that she dressed up for her last day at Southfield Village.

Pictured left to right are Derek Gokee PT, Brenda, and Brian Kemp PTA.

Follow along with our Facebook page to see how we’re helping communities just like yours!

Update on CMS & MAC Claims Processing

Below is an update from AHCA on processing of Medicare claims under the Patient-Driven Payment Model. Please note particularly the part that suggests holding claims until Thursday, October 24.

On October 17th, CMS transmitted is quarterly update to all Medicare Administrative Contractors (MACs) as scheduled. CMS also indicated the MACs would need until October 24th to load, test, and launch the update.

Today, we have heard from several members about problems with claims submitted last Friday and yesterday. This likely is because the MACs require more time (e.g., until the targeted October 24th) to finish installation and testing.

Last evening, we informed CMS (both payment policy staff as well as MAC officers about the responses from MACs to-date (e.g., lower likely payments than billed). We will remain in contact with CMS in the coming days.

For now, we recommend holding submission of claims until October 24th – the date CMS indicated the MACs should be ready. On October 25th, COB, we will be in contact with membership about the result of claims submission. If problems persist, AHCA will escalate the issue quickly.

The final submission deadline for this quarter is November 14th, 2019. Only data successfully submitted by this time is used on the Nursing Home Compare website and in the five star rating calculations.

Tips:

  • Once information is uploaded, check your Final Validations Report which is accessed in the Certification and Survey Provider Enhanced Reporting (CASPER folder) to verify data was submitted successfully.
  • It may take up to 24 hours to receive the validation report.
  • QIES helpdesk is available for assistance help@qtso.com
  • Do not wait until just a few days before the deadline to submit PBJ data for the reasons above.

Click here to learn more.

Article by Skilled Nursing News

The federal government on Tuesday finalized a predicted funding increase for nursing homes, while also formalizing changes to several key quality programs — with an eye toward clarifying some parts of the new Medicare payment model for skilled nursing facilities.

Under the terms of the 2020 final rule for Medicare skilled nursing facilities, the Centers for Medicare & Medicaid Services (CMS) will increase payments to nursing homes by $851 million in the coming fiscal year, which begins October 1 of this year.

That figure represents a slight drop-off from the increase of $887 million projected in the proposed version of the rule, which CMS released back in April; the $851 million comes from a 2.8% increase to the Medicare market basket rate in the final rule, as opposed to a 3% rise in the proposal.

The Tuesday announcement also includes several clarifications related to the Patient-Driven Payment Model, also set to take effect October 1. CMS formally changed the definition of “group therapy” to any modality with two to six residents performing the same or similar activities. That change brings group therapy in SNFs more in line with other care settings, such as inpatient rehabilitation facilities, which use the same definition; CMS currently defines group therapy as activities with exactly four residents.

“As PDPM implementation takes place, CMS believes aligning the group therapy definition serves to improve the agency’s consistency in payment policies across PAC settings,” the agency wrote in a fact sheet about the changes.

Click here to continue reading this article.

NASL Newsletter Feature: US Senator Mike Braun Visits HTS Therapy Office
On April 24, 2019, U.S. Senator, Mike Braun visited Healthcare Therapy Services (HTS) and one of HTS’ partner facilities in Indiana. NASL members were able to talk with the Senator about the hospital observation stays issue that was NASL’s top issue during the Winter Conference in February. The Senator spent about an hour visiting with staff, as well as interacting with residents.

Thank you NASL for featuring us in your latest newsletter!

Pictured: Senator Mike Braun; his wife, Maureen; Cassie Murray, HTS COO; and Keith Yoder, CEO with Hickory Creek Healthcare Corporation

Pictured: Healthcare Therapy Services representative Shaleen Bhatnagar, Regional Director; Stephen White, Rehab Manager; Cassie Murray, HTS COO; and Steve Chatham, President

by Stacy Baker, OTR/L, CHC, RAC-CT, Proactive Medical Review

The Quality Improvement Organization (QIO) Program originated with the Peer Review Improvement Act of 1982 and is authorized by Title XI Part B and Title XVIII the Act. The goal of the QIO program is to improve the quality of care for Medicare beneficiaries, including beneficiary complaints, skilled service termination appeals, and Immediate Advocacy to protect the Medicare Trust Fund. The QIO program is to achieve this goal through performance of various case review directives promulgated by CMS in the QIO Contract.

As of June 8th, important updates apply to the Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QI) in Indiana and Kentucky. Providers should review documents and publications noted below with references to KEPRO. The following actions should take place:

Indiana:

  • Remove KEPRO (effective June 8, 2019) and replace with Livanta information

About Proactive Medical Review
HTS partners with Proactive Medical Review, a third party company who specializes in ensuring compliance with regulatory standards and promoting measurable care excellence. The team includes SNF experienced nurse, MDS, Health Facility Administrator, therapist and reimbursement specialists with experience serving in multi-site contract therapy operations, as corporate directors of quality, clinical program specialists, and Compliance Officers. Proactive is uniquely positioned to assist in managing the many changes and challenges facing providers partnered with HTS. Learn more about our commitment to compliance here.