Just a few pieces of information that you might find helpful:
As you may be aware Palmetto released a Draft LCD for Supervised Exercise training. Both the NCCRA and AACVPR MAC committee gave input on this draft but the future LCD is now available for your review: https://www.cms.gov/medicare-coverage-database/details/lcd-details.aspx?LCDId=37774&ContrId=381&ver=4&ContrVer=1&CntrctrSelected=381*1&Cntrctr=381&name=&DocType=Future%7cAllProposed&s=34%7c48%7c53%7c58&bc=AAAAAAQAAAAA&
It is effective for services performed on or after 11/19/2018.
The Office of the Inspector General (OIG) recently examined appeals and denials of Medicare Advantage and found that MAOs overturned 75% of their own denials during 2014-2016. Furthermore, independent reviewers at higher levels of the appeals process overturned additional denials in favor of beneficiaries and providers. This is highly unusual because beneficiaries and providers rarely use the appeals process, which is designed to ensure access to care and payment. The report recommends that CMS (1) enhance its oversight of MAO contracts including those with extremely high overturn rates and/or low appeal rates and take corrective action as appropriate; (2) address persistent problems related to inappropriate denials and insufficient denial letters in Medicare Advantage; and (3) provide beneficiaries with clear, easily accessible information about serious violations by MAOs. CMS concurred with all three recommendations. For more information you can go to http://oig.hhs.gov/oei/reports/oei-09-16-00410.asp
Cardiac and Pulmonary rehab also remains on the OIG work plan. Previous OIG work identified outpatient cardiac and pulmonary rehabilitation service claims that did not comply with Federal requirements. They will assess whether Medicare payments for outpatient cardiac and pulmonary rehabilitation services were allowable in accordance with Medicare requirements. They will also determine whether potential risks in outpatient cardiac and pulmonary rehabilitation programs continue to exist. https://oig.hhs.gov/reports-and-publications/workplan/summary/wp-summary-0000292.asp
If you are not familiar with the previous OIG work here is the report: OIG audit of Englewood hosp