Medicare Changes 2014-2015 Relevant to Lymphedema Therapy Services An extensive analysis of recent changes in healthcare statutes and policy was presented to lymphedema therapists attending the latest Lymphedema Seminars Networking & Educational Seminar for Lymphedema Therapists in San Diego November 9, 2014. The objectives of this presentation, which may be found on my LymphActivist’s Site at lymphactivist.org/medicare_101-insert.pdf were to: 1- Identify the origins of our healthcare coverage relating to the reimbursement of lymphedema treatment services; 2- Identify 2014 changes to Medicare delivery and reimbursement, issues affecting lymphedema treatment delivery, and changes anticipated for 2015; and 3- Recognize key therapy billing and coding issues, functional limitations coding problems, and therapy cap and exception information. Appendices to the presentation list documentation hints to support audits and a discussion of changes to insurance brought about by the Affordable Care Act that may affect lymphedema therapy and therapists. Subjects covered included: Medicare 101 tutorial- Administrative Contractors, jurisdictions, coverage criteria, flowdown of statutory requirements from the Social Security Act, coverage of lymphedema treatment; ICD-10-CM- Status and schedule, codes for lymphedema; Changes in healthcare policy- Laws and CMS proposed rules, 2014 changes, 2015 changes; Therapy caps- settings, use of –KX modifier, extension of exception process, service cap and mandatory review threshold, manual review process; Functional data collecting and reporting- use of “Other” functional category; Therapy modifier changes- discipline-specific modifiers, addition of SLP codes, new “distinct procedural codes replacing -59 modifier; Changes to outpatient therapy LCDs in compliance with the Jimmo settlement; Change to home health services therapy reassessment timeframe; ABN problem for therapists; Future LCDs on pneumatic compression devices- delayed implementation, serious problems with coverage rules, face-to-face requirement, ordering and referral requirements, PDAC reviews; Reimbursement for bioimpedance spectrometry for lymphedema diagnosis; Multilayer compression system restrictions of use for lymphedema; Reversals of denials by Administrative Law Judges- high rate of MAC denials, RAC reviews, Office of Inspector General work plan, appeal changes to address ALJ backlog, effectiveness of CMS changes; Quality reporting programs- incentive and penalty programs, applicability to therapists, lack of adequate reporting measures; Documentation tips- general, plan of care, cap exceptions, mandatory medical review, DMEPOS need justification, PCD justification; ACA impacts on lymphedema therapy- appeal rights, essential health benefits, California coverage of compression supplies, provider non-discrimination, grace period risk to therapists.
Posted on: Mon, 10 Nov 2014 20:21:59 +0000
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