Will You Be Ready for Cardiac Rehabilitation (CR) Incentive Payment Model

From CMS website https://innovation.cms.gov/initiatives/cardiac-rehabilitation/

On July 25, 2016, the Department of Health & Human Services (HHS) announced a model that will test the effects of payments that encourage the use of cardiac rehabilitation services. The cardiac rehabilitation incentive payment model would test the impact of providing an incentive payment to hospitals where beneficiaries are hospitalized for a heart attack or bypass surgery, which would be based on beneficiary utilization of cardiac rehabilitation and intensive cardiac rehabilitation services in the 90-day care period following hospital discharge. Increasing the use of cardiac rehabilitation services has the potential to improve patient outcomes and help keep patients healthy and out of the hospital.

Model Details

Under this model, hospitals may use this incentive payment to coordinate cardiac rehabilitation and support beneficiary adherence to the cardiac rehabilitation treatment plan to improve cardiovascular fitness. These payments would be available to hospital participants in 45 geographic areas that were not selected for the cardiac care bundled payment models, as well as 45 geographic areas that were selected for the cardiac care bundled payment models. This test will cover the same five-year period as the cardiac care bundled payment models. Standard Medicare payments for cardiac rehabilitation services to all providers of these services for model beneficiaries would continue to be made directly to those providers throughout the model.

CMS proposes establishing a two-part cardiac rehabilitation incentive payment that would be paid retrospectively based on the total cardiac rehabilitation use of beneficiaries attributable to participant hospitals:

  1. The initial payment would be $25 per cardiac rehabilitation service for each of the first 11 services paid for by Medicare during the care period for a heart attack or bypass surgery.
  2. After 11 services are paid for by Medicare for a beneficiary, the payment would increase to $175 per service paid for by Medicare during the care period for a heart attack or bypass surgery.

Based on Medicare coverage, the number of cardiac rehabilitation program sessions would be limited to a maximum of two one-hour sessions per day for up to 36 sessions over up to 36 weeks, with the option for an additional 36 sessions over an extended period of time if approved by the Medicare Administrative Contractor. Intensive cardiac rehabilitation program sessions would be limited to 72 one-hour sessions, up to six sessions per day, over a period of up to 18 weeks.

https://innovation.cms.gov/initiatives/cardiac-rehabilitation/

PCNA newsletter and Reimbursement for Nutritional Services

Our Nutrition chair Judith M. Hinderliter, MPH, RD, LDN, CPT wanted to make sure you saw the wonderful e-News letter from PCNA (Preventive Cardiology Nursing Association). The Holiday Heart-Healthy Eating Guide from AHA is mentioned as well as other helpful information. She also added the power point on reimbursement from Monday if you weren’t able to listen.

Reimbursement for Nutrition Services Presentation Slides

http://pcna.informz.net/informzdataservice/onlineversion/ind/bWFpbGluZ2luc3RhbmNlaWQ9NTIxNTMyNCZzdWJzY3JpYmVyaWQ9MTA3MTk4Njk3MA==

Outpatient Pulmonary Rehab (HCPCS G0424) Prepayment Service-Specific Targeted Medical Review Results for May – July, 2015

Outpatient Pulmonary Rehab (HCPCS G0424) Prepayment Service-Specific Targeted Medical Review Results for May – July, 2015

Palmetto GBA performed service-specific prepayment targeted medical review on claims for Outpatient Pulmonary Rehab, HCPCS G0424, in North Carolina, South Carolina and Virginia/West Virginia. The results for the ninth quarter of targeted medical review, for claims processed May 1 – July 31, 2015 are presented in this article.

http://www.palmettogba.com/palmetto/providers.nsf/ls/JM%20Part%20A~A28RPF5433?opendocument&utm_source=J11AL&utm_campaign=JMALs&utm_medium=email

AACVPR initiative –

You may recall the huge initiative AACVPR embarked on last year entitled Finding The N. That campaign resulted in identifying over 2600 cardiac rehabilitation programs and over 1700 pulmonary rehabilitation programs in operation in the United States. The next steps are identifying the staffing make-up of these programs.

To assist, AACVPR has created a survey that takes about 10 minutes to complete. Here is where they need your help. Please complete the survey for your respective programs and let me Ash Walker know if you have questions. Thank you for your help!

https://www.surveymonkey.com/s/R7YCV7T

Cardiopulmonary Rehab Knowledge tests for outcomes

One of the ways to track outcomes is through a knowledge test.  Here is some information about knowledge tests for cardiac and pulmonary patients.

cardiac knowledge test

Development and Valid of_Pulmonary know test

Local ENC nurse gets creative to raise awareness

 

http://insurancenewsnet.com/oarticle/2014/07/05/local-nurses-video-message-about-heart-disease-gaining-in-popularity-a-526451.html

Summary of the AACVPR J-11 MAC Committee teleconference

From Connie Paladenech following teleconference on 5/15/2014

  • Pulmonary Rehab audits are continuing across the J-11 Region with the majority of denials centered around documentation of physician involvement, psycho social evaluation (written evaluation of patient’s mental and emotional functioning as it relates to ability to participate in, and complete a program of pulmonary rehabilitation) and a patient centered outcomes summary completed by physician. (Physicians can bill through their offices for patient assessment.)
  • There have been a small number of ADRs for non-COPD records reported in the J-11 Region.
  • Physician extenders’ orders for Cardiac and Pulmonary Rehabilitation will not be accepted by Palmetto GBA per Dr. Feliciano. Orders must be from MDs or DOs.
  • There has been no new information related to webinars and training previously mentioned by Dr. Feliciano. The J-11 MAC Committee will contact Dr. Feliciano to get an update on status of the webinars.
  • Although CMS has approved coverage of CHF as a covered diagnosis for cardiac rehabilitation, the MACs have not received specific instructions from CMS as to how to process claims for these services. Palmetto GBA will deny payment for Cardiac Rehabilitation until they receive instruction from CMS regarding procedures for processing claims. Options for programs wishing to begin billing for CHF include holding claims until Palmetto notifies providers that they are ready to accept claims. It may be helpful for programs to ask their hospital compliance offices to contact Palmetto for information regarding how best to handle billing for these services.
  • The J-11 MAC Committee will contact Dr. Feliciano to request his advice on how best to CHF. We will post updated information on this website as soon as it is received.

Updates regarding Reimbursement and CMS

CMS is changing how hospital billing offices will determine eligibility status for Medicare coverage of services.  Instead of the Common Working File (CWF) organizations will now access the HIPAA Eligibility Transaction System (HETS)

For more information go to:

http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/SE1249.pdf

You will need to speak to your individual billing office to discuss access.

Federal Register for Pulmonary Rehab

This has been posted for your convenience and reference – this is not a new document

FedReg pulmonary rehab

Please Note: Date Change for State Pulmonary Rehabilitation Meeting

The state pulmonary rehabilitation meeting will be held on Tuesday August 9th, from 10am til 2pm at High Point  Regional.  This is a change from the original date (August 2nd).  The reason for the change is Dr. Mark Pilley, Medicare Administrative Contractor (MAC) will be able to attend and speak on various issues that effect our programs. The meeting will have a capacity of 35 attendees, so please let John Rotroff  know if you plan to attend.  For additional information please contact:

John Rotroff  RRT RCP

336-878-6000 (Ext 2482)

JRotroff@HPRHS.com