CMS Releases CY 2013 Proposed Rules for Physician Fee Schedule

CMS Physician Fee Schedule Proposed Rule for CY 2013 Impact to Rehabilitation Providers:

• Claims based data collection based on the provision of the Middle Class Tax Relief and Jobs Creation Act (MCTRCA).  This would be for informational purposes only and not impact reimbursement of the submitted claim.  CMS would add codes and modifiers which would have to be appended to submitted claims by the provider.  The effective date would be 1/1/2013; however, there would be a grace/testing period from 1/1/13 through 7/1/13.  A table of proposed codes (format of codes) is provided on page 160 of the proposed rule.  Reporting frequency for G-codes and associated modifiers be once every 10 treatment days or at least once during each 30 calendar days, whichever time period is shorter. (pg 157-179)
• New codes to establish coordination of care between multiple provider settings. (pg 180)
• The projected cut in the fee schedule without action from Congress is approximately 31% effective 1/1/2013; however, through changes proposed in this rule outpatient therapy will realize an overall 3% increase for payment on services.
• The CY 2013 Therapy Cap amount will be set forth in the final rule (pg 150)

NARA will be providing a more detailed summary of this rule in the upcoming week.  For additional details on this proposed rule please click here.  Comments regarding this proposal are required by 5pm 60 dates after publication.  Comments can be submitted: Electronically:  www.regulations.gov and following the instructions under the More Search Options tab. Regular mail:  Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention:  CMS-1590-P, PO Box 8016, Baltimore, MD  21244-8016. Express/Overnight Mail:  Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-1590-P, Mail Stop C4-26-05, 7500 Security Boulevard, Baltimore, MD  21244-1850.   CMS Home Health & Hospice Proposed Rule for CY 2013 CMS has released their 2013 Proposed Rule titled:  Medicare Program; Home Health Prospective Payment System Rate Update for Calendar Year 2013, Hospice Quality Reporting Requirements, and Survey and Enforcement Requirements for Home Health Agencies.  Overall, this proposed rule proposes:

• Updates the Home Health Prospective Payment System (HH PPS) rates to effectively decrease payments by $20 million;
• Requirements for the Hospice quality data reporting program;
• Establish requirements for unannounced, standard and extended surveys of home health agencies (HHAs) and provide a number of alternative (or intermediate) sanctions that could be imposed if HHAs were out of compliance with Federal requirements;
• Alternative sanctions that could be imposed instead of or in addition to termination of the HHA’s participation in the Medicare program, which could remain in effect up to a maximum of 6 months, until the HHA achieved compliance with the HHA Conditions of Participation (CoPs), or until the HHA’s provider agreement was terminated.

Some of the proposals contained in this rule impact therapy providers:

• If a required assessment for the 13^th, 19^th, or 30^th day is missed, therapy coverage would resume with the visit during which the late reassessment is completed rather than the after the late assessment is completed.  (pg 79)
• In cases of multiple disciplines, if the reassessment is missed by only one discipline, coverage would cease only for that one discipline.  (pg 80)
• Timing of the 13^th or 19^th assessment requirement:  when a patient lives in a rural area or documented circumstances outside the therapist’s control prevent the completion of the reassessment visit on the 13^th or 19^th visit, this requirement can be met by the therapist making the reassessment visit on the 11^th or 12^th for the required 13^th visit or the 17^th or 18^th for the required 19^th visit.
• Additionally for patient’s receiving multiple disciplines, the reassessment visits can be made during the 11^th, 12^th, or 13^th visit for the required 13^th reassessment visit and the 17^th, 18^th, or 19^th for the required 19^th reassessment.

For additional details on this proposed rule please click here.  Comments regarding this proposal are required by 5pm on September 4, 2012.  Comments can be submitted: Electronically:  www.regulations.gov and following the instructions under the More Search Options tab. Regular mail:  Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention:  CMS-1358-P, PO Box 8016, Baltimore, MD  21244-8016. Express/Overnight Mail:  Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-1358-P, Mail Stop C4-26-05, 7500 Security Boulevard, Baltimore, MD  21244-1850.