CMS Special Open Door Forum Summary - September 5, 2012

CMS Special Open Door Forum Summary Manual Medical Review Process for Part B Therapy Claims Effective October 1, 2012  

On September 5, 2012, CMS conducted a special open door forum regarding the Manual Medical Review Process for Part B Therapy Claims which is effective on October 1, 2012.  There was not a lot new information provided to listeners; however, they did review a PowerPoint presentation which is used by contracts to train claim reviewers.  They felt this might be helpful for providers to prepare documentation in a way that demonstrates the need for a patient to be receiving skilled services.  CMS stresses providers need to "paint" a complete and thorough picture of the health and needs of the patients in order to support the skilled needs.  Click here for the PowerPoint.  During the call, Mr. Mills also referred to a transmittal containing the information every provider, regardless of contractor, would need to supply when submitting for preapproval of therapy.  NARA has provided a summary of the information in the transmittal, click here for the summary.  For the full transmittal click here.  Below is some additional information you may want to review including the voluntary ABN updated manual instructions, MLN article related to ABNs, and beneficiary letter regarding the threshold.  If you have not received your letter from CMS informing of which phase you are in please visit:  https://data.cms.gov/dataset/Therapy-Provider-Phase-Information/ucun-6i4t.  In the upper right corner, below Create An Account, you will see a magnify glass with "Find in this Dataset" - this is where you can enter your NPI number and press enter.  It will search the table for your facility or provider's NPI number and return the NPI number with the Therapy Phase.  If the NPI number does not appear then you are in Phase 3. NARA will be presenting an educational session on the Manual Medical Review Process at the Fall Conference in Las Vegas October 17 - 19, 2012.  We encourage you to attend this conference to hear this and all the other informative sessions.  This may be a hot topic of discussion during our breakout session and leadership roundtable!  For more information or to register visit our website at:  www.naranet.org/conferences - register before September 15th to take advantage of the early bird discount!