Communication Related to Modifiers from the PT, OT, and ST National Organizations

APTA: (September 29, 2014) CMS Says Keep Using 59 Modifier for Now Until you receive further notice, keep on using the 59 modifier in reimbursement claims to indicate that a health care common procedural code (HCPCS) represents a service that is separate and distinct from another service to which it is paired under the Correct Coding Initiative (CCI) program—that’s the bottom line from the Centers for Medicare and Medicaid Services (CMS), which recently responded to an inquiry from APTA as to when—and whether—physical therapists should use a set of new modifiers announced by CMS in August. The clarification was forwarded to APTA by CMS after some physical therapists questioned whether they should begin using the new modifiers. The CMS answer: not yet. In August, CMS issued a transmittal describing new modifiers—XE, XS, XP, and XU—intended to be used to define subsets of the 59 modifier. The new modifier codes have not been implemented, and CMS has advised that PTs should not use the modifiers until they receive further notice AOTA: (November 5, 2014) Occupational Therapists Should Continue Modifier 59 Use CMS recently released transmittal 1422 describing specific modifiers to be used in place of Modifier 59 (referred to as “the X{EPSU} modifiers”) for distinct procedural services. AOTA reached out to CMS for more clarification regarding the use of these new modifiers. For now, the new modifiers will not apply to occupational therapy services. OTs can continue to use Modifier 59. Occupational therapists can keep using the 59 modifier until CMS issues specific instructions about the use of the new X{EPSU} modifiers. Because the X{EPSU} modifiers were developed to be...

CHS Announces 2015 Clinical Excellence Campaign

Skilled Therapy Delivered in a Person-Directed Manner: The CHS Expectation. Our 2015 Clinical Excellence Campaign is a focused effort to ensure that this expectation is met by all CHS teams. Our focus is on our 5 Core Programs: Dementia Management Falls & Balance Medical Complexities in Rehabilitation Short Term Rehabilitation Long Term Care November 2014 our management team met for an all day workshop in preparation for our campaign. Standards for each program were introduced. Our Rehab Directors and Regional Managers worked with the corporate clinical team to do a baseline assessment of programs at each site and to begin developing a plan to ensure we are meeting the standards. In 2015 our corporate clinical team will make Quarterly Clinical Excellence Visits to each site. They will review the team’s Action Plan, assess progress, meet with team to report and to discern support needs, and together adjust Action Plan. Together we will meet the challenge of clinical...

3 Teams Recognized for Person Directed Therapy

CHS Therapy Teams at Ashton Creek Health and Rehabilitation Center, Englewood Health and Rehabilitation Center, and Ossian Health and Rehabilitation Center all completed Person Directed Therapy Statements of Achievement and were recognized as CHS Person Directed Therapy Teams in December . Jeff Clayton, CEO of CHS and Jan Bays, Vice President of Clinical Services presented teams with statements of our CHS Criteria and the 10 Eden Principles suitable for hanging in the department to remind all of the teams’ achievement. These teams join with Heritage Pointe to make our Fort Wayne Region the 1st to be 100% Person Directed Care. All of these teams have history of individualized treatment. Culture change has enhanced the quality of their relationships and recognition of the importance of meaningful activities incorporated in care. At Ossian, the therapy won the annual Christmas decorating completion by therapists and patients working side by side to turn the department into a ginger bread house. The transformation happened throughout the month of December as part of therapy treatment. Balance, sequencing, reaching, stooping, planning are just a few of the skills incorporated into the project. At Englewood, a patient who was facing an extended period of NWB learned that she could continue to be very useful without standing by joining with Activities to man the mobile lending library. She is the Englewood librarian! At Ashton Creek, not only did a patient have the opportunity to make her favorite macaroni and cheese as part of her IADL training post surgery, but she also was able to teach her therapists how to make the from scratch cheese sauce. These are examples...

Recent Updates from CMS

Review: The Protecting Access to Medicare Act extends the authorization for physician reimbursement under Medicare under current law (Sustainable Growth Rate or SGR) through March 31, 2015, postponing the efforts to reform and improve Medicare physician reimbursement methodology or the “Doc Fix” yet again. Protecting Access to Medicare Act of 2014 states: Physician Fee Schedule cut of 23.7% is delayed till March 31, 2015 (replace it with a 0.5% conversion factor through December 31, 2014 and a 0.0% update from January 1, 2015 through March 31, 2015) Therapy Cap Exceptions Process (KX modifier) would be extended through March 31, 2015 (including manual medical review) Caps and exception process includes hospital outpatient departments through March 31, 2015. ICD-10 delayed till October 1, 2015.   Currently, Congress has a bipartisan agreement on Sustainable Growth Rate (SGR) repeal policy and the Senate has included provisions to repeal and reform the Medicare therapy cap once and for all. Because of this agreement, it’s imperative that Congress acts on a permanent solution before adjourning at the end of the Congressional year. Completing this legislation before the end of the year provides an opportunity to end the pattern of yearly extensions that puts access to medically necessary therapy for ~1 million Medicare beneficiaries at risk. Delaying action on this legislation until next year would add the burden of reworking the policy and running up against the March 31, 2015 deadline. The 114th Congress’ new members are being sworn into office on January 3, 2015 and meeting on January 6, 2015.  The current Congress will be in Lame Duck session.  While it is hopeful they will...