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MEDICARE UPDATE

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The Council, through it's contacts has been extremely active in following the progress of the Medicare Bill (HR 6331) and trying to influence its outcome.

I have been in close contact with Senator Schumer's office, CMS and NGS and  the latest word is that the bill will be revisited early this week and  while  many aspects of the bill are unresolved and politically sensitive, there  is  much pressure to keep the Exceptions Process at least until January even  if  the caps themselves remain in place.Let's not forget that in January, whatever way the elections turn out, there will be a new team in Washington  both in the White House and Congress.

We will keep you posted as developments occur.

Alan Leventhal PT
Medicare Chairman

MEDICARE UPDATE 4-12-07

Now that Congress is back in session, we should all be contacting our Congresspeople and Senators to SUPPORT AND SPONSOR both the bill to repeal the cap (S450 – HR748) and the Medicare Direct Access Bill (S932 – HR1552).

Another bill has been introduced that needs to be vehemently OPPOSED. It has the innocuous title of “Medicare Access to Physical Medicine and Rehabilitation Services Improvement Act – HR 1846, It would allow athletic trainers and lymphedema therapists to practice under the “incident to” provisions, now limited to qualified PTs, OTs, and SPs only.It is nothing more than a bald attempt to expand physician’s referral for practice (POPTS). It has been introduced before and never went anywhere – but we cannot take chances. IT MUST BE OPPOSED and your legislators must know your feelings in the matter lest they inadvertently support it.

While May 23 is the official deadline for getting your NPI number, CMS has contingency plans for those who could not accomplish this in time. HOWEVER, WE STRONGLY RECOMMEND THE ACQUISITION AND USE OF THE NPI AS SOON AS POSSIBLE AND THE OBTAINING THE NPIs OF REFERRING PHYSICIANS.It is in your own best interests.

Alan Leventhal, PT
Medicare Chairman

MEDICARE UPDATE 3-10-07

DEADLINE FOR USE OF NEW CMS 1500 FORMS POSTPONED.

SOME FORMS INCORRECTLY FORMATTED AND SHOULD NOT BE USED.

CMS HAS EXTENDED THE DEADLINE FOR USE OF NEW 1500 FORMS INDEFINATELY BUT IS TARGETING JUNE 1,2007.

All incorrect forms submitted will be returned and should be sent to the supplier of the forms for replacement or refund. The best way to identify if your CMS-1500 (08-05) version forms are correct is by looking at the upper right hand corner of the form. On properly formatted claim forms, there will be approximately a ¼ inch gap between the tip of the red arrow above the vertically stacked word”CARRIER” and the top edge of the paper. If the tip of the red arrow is touching or close to touching the top edge of the paper, then the form is not printed to specifications.

Alan Leventhal, PT
Medicare Chairman

REPORT OF THE MEDICARE CHAIRMAN

It has – and promises to continue to be - an active time.

We are monitoring and providing input in the regulatory area both with CMS in Baltimore and our local Medicare intermediaries. MedPAC has advised CMS to do further studies on rehabilitation payments before changing the system. We are studying the MedPAC document and will be offering constructive criticism as the process moves along.

There have been many inquiries from members on various situations relative to Medicare and the Exceptions Process. These have been or are in the process of being answered – sometimes necessitating referral to high echelons of the fiscal intermediaries.

The focus is now shifting to the legislative front. The Exceptions Process expires 12/31/06 and we have been contacting key Congresspeople and Senators on this issue. Sample letters are available for member’s use. The hope is for repeal of the caps but the realistic expectation is for an extension of the Exceptions Process. We will be very active in this area as the Congressional session continues.

Reimbursement continues to be a primary concern as without proper and fair reimbursement, we cannot remain a viable profession.

SPECIAL ANNOUNCEMENT

MARK YOUR CALENDARS!!! MAY 15 MEDICARE MEETING

Kathy Dunphy Assistant Vice President of Beneficiary and Professional Relations for National Government Services (Formerly Empire Medicare Services) will be our keynote speaker at our May 15 meeting. We are pleased to offer her expertise in advising the PT community on the Exceptions Process, KX Modifiers, and Medicare issues. This meeting will be open to members and to guests from the PT community. Guests MUST RSVP to info@nycouncilpt.org.

COUNCIL REPRESENTED AT OWNER’S FORUM

Anthony Sarola, our Legislative Chairperson and Joseph Sullivan, our Chairperson were among the speakers on April 14 at the Hospital for Special Surgery Rehabilitation Network Owner’s Issues Discussion Forum. Their topics included Legislative Update and Private Practice Management with Decreasing Reimbursement.

COUNCIL OUTREACH TO PT STUDENTS

Council has been implementing our Student Outreach Program, an effort aimed at educating future PT’s about issues affecting our field. We are currently arranging for speaking engagements at most PT programs in the area.