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.