APTA Government Affairs released a webinar with details on the Medicare Cap and other items included in the budget bill repealing the cap.
The link can be found on the APTA website at www.apta.org/insiderintel. Click on the February 15 recording posted under the "Archives" section.
The budget bill contained the following provisions:
Permanently extend the current exceptions process.
Claims that go above $2,010 (adjusted annually) still will require the use of the KX modifier for attestation that services are medically necessary.
The threshold for targeted medical review will be lowered from the current $3,700 to $3,000 through 2027; however, CMS will not receive any increased funding to pursue expanded medical review, and the overall number of targeted medical reviews is not expected to increase.
Claims that go above $3,000 will not automatically be subject to targeted medical review. Instead, only a percentage of providers who meet certain criteria will be targeted, such as those who have had a high claims denial percentage or have aberrant billing patterns compared with their peers.
Medicaid Managed Care Concept Paper - Therapists Not Included
DHHS Medicaid issued a managed care concept paper, “Prepaid Health Plan Network Adequacy and Accessibility Standards”recently to consider standards for perspectives of beneficiaries, plans and providers on what each defines as an “adequate and accessible” network. The proposed network does not include physical therapists, occupational therapists, respiratory therapists or speech/language pathologists.
NCPTA will be advocating for the inclusion of therapists in the Appendix B: Providers Subject to Specialty Care Access Standards. We are encouraging members to also comment on these standards. Comments can be emailed to Medicaid, through March 29, 2018, at email@example.com.
The Medicaid Outpatient Specialized Therapies Stakeholder Committee held a committee meeting on February 1 to discuss adult therapy services. Flo Moses, Director for Payor Relations and Liz Reeser, Payor Relations Committee member attended the meeting on behalf of NCPTA. Medicaid’s Outpatient Specialized Therapies staff have been charged with developing policy recommendations to address the opioid crisis. Due to the complicated clinical coverage policy for therapy services for adults the group was asked to make new recommendations for therapy services for adults. Read More
North Carolina Student Conclave
LEARN. INTERACT. GET INVOLVED. Hosted by the North Carolina Student Special Interest Group
All North Carolina DPT & PTA students are encouraged to attend!
March 24, 2018
Breakfast & Lunch Provided
Where Mary Duke Biddle Trent Semans Center
for Health Education
Duke University Medical Center
Durham, NC 27710