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Medicare Compliance & Reimbursement

Rehab:

REHAB PROVIDERS CHEER FEE SCHEDULE FIX

Published on Thu Dec 11, 2003

2004 physician fee schedule speaks to PT-OT-and SLP-specific issues. 

Congress stepped in to save rehab providers from the 4.5-percent reduction in Medicare reimbursement quoted in the 2004 physician Fee Schedule .

Thanks to the new Medicare reform bill, rehab providers will see a 1.5-percent increase in reimbursement in both 2004 and 2005.

The tricky issue of incident to billing rules, however, remains unresolved. "The problem involves therapists and physicians who set up therapy programs and don't use licensed therapists," reports attorney Donna Thiel with Morgan Lewis & Bockius in Washington.

Instead, these programs often utilize nurses or physical trainers, and therapists worry that the services being rendered (and reimbursed) aren't true therapy services. "They can use any kind of personnel, and the physician signs off on it and bills it. But if it wasn't provided by an OT, that patient did not get occupational therapy," argues Judy Thomas with the American Occupational Therapy Association.

"Therapists want to make sure that the services being rendered and billed to Medicare are consistent services," Thiel continues. And the Centers for Medicare & Medicaid Services apparently wants that as well; otherwise, the agency wouldn't have brought the matter up in the first place, she notes.

"We're really glad that [CMS is] sensitive to the issue," says Dave Mason, vice president for government affairs with the American Physical Therapy Association.

The rehab industry wants CMS to put licensure requirements in place for incident to billing of therapy services. But that's a thorny issue, Thiel worries. "If Medicare is going to say you have to meet a certain criteria going forward, they can either defer to the state practice acts, or develop their own requirements," she explains. "I think that's where we might see some controversy."

Given the financial impact on everyone involved, the incident to issue still is in the discussion phase, and is likely far from resolution, experts agree. CMS is going to review all the comments it has received on the issue and decide whether to make a future proposal.

Other discipline-specific rehab issues in the fee schedule:

  • SLP: Practice expense for code 92507. The American Speech-Language-Hearing Association questioned the proposed 28-percent reduction in the practice expense for CPT code 92507 (Treatment of speech, language, voice, communication, auditory processing and/or aural rehabilitation status). CMS based this change on a reduction of clinical staff time, which ASHA pointed out was not reasonable when treating an adult.

    In the final Fee Schedule , CMS acknowledged that the agency is unclear on how much time should be assigned to this code, and will - for the time being - set the clinical staff time at 58 minutes (the average of the clinical staff time needed during a speech therapy session for a child and the time suggested by ASHA for an adult). CMS has asked ASHA to present CPT code 92507 for further discussion and review before the Practice Expense Advisory Committee.

  • PT: Iontophoresis electrode pricing. When CMS released the proposed fee schedule, APTA noted that a rank order anomaly was caused by the increased price for the electrode used for CPT code 97033 (Iontophoresis). A "pair" of electrodes cost $16 in 2001 but had increased to $23.98 under CMS' current repricing initiative, the fee schedule explains.

    The confusion stemmed from a misunderstanding on CMS' part about how these electrodes are packaged. Upon realizing they come in a "kit" containing the complete set of electrodes needed to provide an iontophoresis treatment, CMS changed the supply list in its database "to reflect that there is one kit, not two electrodes, at the proposed price of $11.99," the final fee schedule notes.

    "That's not a major change, but in order to keep everything on the fee schedule more of less in balance, it was an appropriate action to take," Mason tells MLR.

  • OT: New CPT code for assistive technology assessment. CMS has added CPT code 97755 (Assistive technology assessment) to its repertoire, cheers Thomas. AOTA and the Rehabilitation Engineering and Assistive Technology Association of North America (RESNA) worked together to bring this code into existence. OTs should use this code when assessing severely disabled people for high-tech equipment, such as computer-assisted equipment, Thomas explains. "Also, they added assistive technology language to 97537, which is community living integration," she notes.

    Editor's Note: The complete fee schedule is at http://a257.g.akamaitech.net/7/257/2422/14mar20010800/edocket.access.gpo.gov/2003/03-27639.htm.

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