Filed under: Industry Updates — Editor @ 10:34 am

U.S. Capitol BuildingIt is time to let Congress know what you think regarding the Therapy Cap and Fee Schedule. Congress has been very clear: it will not take action without input from constituents. If you only send 1 advocacy e-mail or make 1 advocacy phone call this year, please do it this week. This is the greatest opportunity for us to influence congress and remind them of the stakes of allowing the therapy cap and the SGR adjustment to return on January 1st. (more…)

CMS Releases Final Rule for 2014

Filed under: Industry Updates — Editor @ 2:12 pm

cmsannouncementNoteworthy items in the final rule for Marden Employees:

Physician Fee Schedule

* Reduction of 20.1% will be effective January 1, 2014 unless Congressional action is taken

New Speech Codes & MPPR

* New CPTs for speech (92521: evaluation of speech fluency; 92522: evaluation speech sound production; 92523: speech sound language comprehension; 92524: behavioral and qualitative analysis of voice and resonance) will be subject to the multiple procedure payment reduction (MPPR) on therapy services on an interim final basis while public comments are being received. These codes replace CPT code 92506 (speech/hearing evaluation) beginning January 1, 2014.

Therapy Caps/Manual Medical Review

* Physical and Speech therapy combined cap will increase from $1900 to $1920;
* Occupational therapy cap will increase from $1900 to $1920;
* Therapy cap exceptions and manual medical review (MMR) processes are set to expire on December 31, 2013 and require congressional action to be extended

Critical Access Hospitals (CAH) & Outpatient Therapy

* CMS is finalizing their proposal to apply the therapy caps and related policies to outpatient therapy services furnished by a CAH beginning on January 1, 2014 in order to properly apply the law that established the therapy caps (Balanced Budget Act of 1997).

Hospital Outpatient Therapy

* As of December 31, 2013, the mandate for the therapy cap to be applicable to hospital outpatient therapy (non-Critical Access Hospitals) departments expires. in order for this process to be extended into 2014 congressional action is required.

House Energy and Commerce Committee Approves “Doc Fix” Bill [08-10-13]

Filed under: Industry Updates — Editor @ 2:00 pm

Seal_of_the_United_States_House_of_Representatives.svgJust before Congress broke for the August recess, the House Energy and Commerce Committee approved a bill that would eliminate the Sustainable Growth Rate (SGR) methodology under the physician fee schedule, implement a new Medicare reimbursement system for physicians and providers paid pursuant to the fee schedule, and establish a process for the development of Alternative Payment Models (APM.) While the Committee’s action marks significant progress in the effort to fix the physician fee schedule, a long road lies ahead. (more…)

CMS Finalizes Fiscal Year 2014 Payment and Policy Changes for Medicare Skilled Nursing Facilities [08-02-13]

Filed under: Industry Updates — Editor @ 2:40 pm

cmsannouncementOn July 31, 2013, the Centers for Medicare & Medicaid Services (CMS) issued a final rule [CMS-1446-F] outlining fiscal year (FY) 2014 Medicare payment rates for skilled nursing facilities (SNFs). The major provisions of the final rule are summarized below.  (Please note the Reporting of Distinct Therapy Days section.) (more…)

CMS Proposes Payment Changes for Medicare Home Health Agencies for 2014 [06-28-13]

Filed under: Industry Updates — Editor @ 4:11 pm

cmsannouncementOn June 27, CMS announced proposed changes to the Medicare home health prospective payment system (“HH PPS”) for calendar year (“CY”) 2014. CMS projects that Medicare payments to home health agencies in CY 2014 will be reduced by 1.5%, or $290 million relative to CY 2013, based on the proposed policies. (more…)

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