This is an update from the information sent earlier today by Julia Rice on behalf of APTA.  Virginia PTs MUST act now to influence your Senators to support this bill. 

FYI on Virginia Senators: Senator Webb voted in support of the bill. Senator Warner voted against the bill.  We only have a few days before the likely revote on the bill (that will take place sometime between July 7 and July 10). This is the last opportunity to avoid the drop in medicare reimbursement and re-establishment of the CAP.  Everyone needs to contact Senators Webb and Warner ASAP. You can go to the APTA website, legislative advocacy center, to obtain a formated email message you can send to each senator. Individualize each message by thanking Senator Webb for his support and urge him to continue to support on revote next week. Ask Senator Warner to vote Yes for this bill when it comes up for revote.  

APTA also has a page where patients can send a message to their Senators to ask them to support the bill. legislators are particularly sensitive to the opinions of patients (the general public) in their district.

Please act now. It only takes a couple minutes to send a message.

Rita Wong EdD, PT
PT Department Chairperson
Professor of Physical Therapy
Marymount University
2807 N Glebe Rd
Arlington, Va 22207

voice: 703-284-5982
Fax: 703-284-5981

Recently released by APTA:

CMS Issues Temporary 10-Day Hold on Claims

Action Still Needed in Congress to Prevent Cuts and Caps!

The Centers for Medicare and Medicaid Services (CMS) has indicated
that it will instruct its carriers to hold physician and non-
physician claims 10 days beginning on July 1, 2008.    This 10-day
hold, which includes physical therapy claims, will allow CMS to
investigate its options for implementing schedule cuts and the
therapy cap.   Without Congressional action, CMS will proceed to
implement the 10.6% after the hold for services delivered on or
after July 1, 2008.  This hold will also impact scheduled reductions
to rural providers and claims for physical therapy and speech
language pathology services that may be subject to the $1810 therapy
cap under Medicare.

Congress will reconvene on Monday, July 7th.   Senate Majority
Leader Harry Reid (D-NV) has indicated that he will schedule another
vote on HR 6331 to attempt to meet the 60 votes needed to proceed
with Senate action.   If the Senate meets the 60 votes to proceed
and passes the legislation, the President would still need to sign
the legislation to avoid the 10.6% cut in payments for the rest of
2008 and the therapy cap being implemented without an exceptions
process.

Stay Active!
It is imperative that APTA members continue to contact their Members
of Congress THIS WEEK to strongly encourage Congress to act to
prevent the 10.6% cuts in payments to providers under the Medicare
physician fee schedule and provide an exceptions process to the
therapy cap.   Below are ways to let your voice be heard:

Attend events or meet with your member of Congress personally while
they are back in their districts for the 4th of July recess.
Members of Congress will be on recess until July 7.  During this
time, many members of Congress will be participating in local
parades, attending events and holding meetings back in their
districts providing an opportunity for physical therapists to reach
out to their Congressional representatives in person.
Call your Representative and Senators.   To reach the Capitol hill
offices of your Representative and Senators, contact the Capitol
switchboard at 202/224-3121.   Ask the operator to direct you to
your Representative and /or Senators.   If you do not know your
Representative, you can find out by utilizing the Legislative Action
Center.
Send an email, fax or letter to your Representative and Senators.
For sample letters and easy access to contacting your Members of
Congress by electronic means or download and print letters, utilize
APTA's Legislative Action Center.
Request your patients to contact Congress through APTA's Patient
Action Center. This site is designed to educate patients on the
issue and provide easy access to form emails and letters for them to
contact Congress.
Stay Informed!
APTA will continue to issue action alerts and information bulletins
to keep you up to date on the latest developments on the Medicare
bill.  In addition, please utilize APTA's webpage to stay informed
and active on this issue, please go to www.apta.org/advocacy.

Be Prepared!
To be prepared for the July 1, 2008 implementation date of the 10.6%
reduction in payments under the Medicare Physician Fee Schedule and
the expiration of the therapy cap exceptions process, APTA has
created a resource center.   This resource center contains
information and Frequently Asked Questions on how the therapy caps
will be implemented, additional Medicare changes that will go into
effect on July 1, 2008, and how to assist patients manage these cuts
in physical therapy services.   Visit this resource center by
selecting Medicare on the APTA home page at www.apta.org.

Please review the information below that is currently posted on Highmark's website. Northern Va ( counties specified below) is part of the J12 jurisdiction which has been awarded to Highmark to administer. Therapists practicing in Northern Va have likely already received paperwork from Highmark. Previously it was published that all of VA would be considered within the J11 jurisdication. This MAC has not yet been assigned.

___________________________________________________________

Communications Specific to our PA/MD/DC Part A Providers

Provider Impacts for MD/DCMA/DE Part B Providers

VCU/MCV Physical Therapy students are participating in the program
below and request your support:


SHAKE A LEG, LEND A HAND!


DONATE YOUR USED PROSTHETICS OR BRACES to Physicians for Peace TODAY
and help those in need walk free!
Saturday June 7th, 2008 1:00 – 4:00PM
Richmond Braves Stadium
Physicians for Peace designed the Walking Free program to assist
developing nations by establishing sustainable prosthetic and
rehabilitation centers. We will be collecting used prosthetic
devices, parts and braces and breaking them down into component
parts for use in the Walking Free program.

For more information about donating limbs or financial support call
Physicians for Peace at 757-625-7569. For more information on the
Walking Free program visit www.physiciansforpeace.org

In 2009, the VPTA is planning to host a forum for payers. This exciting event will give the VPTA an opportunity to reach out to a number of insurers and offer information to facilitate a better understanding of our ever-changing profession and the value that we bring to the health of Virginians.

The success of this venture is largely dependant on the access that the VPTA has to payer contact data. This is where YOU CAN HELP!

Currently we are building an invitation list and ask that you share any insurance contacts that your office or facility may utilize in interfacing with third party payers. The names that you share can be those of case managers, fraud investigators, claims processors, provider network managers, etc.  

The information that we need is as follows:

Full Name
Company
Position
Mailing Address
phone
fax
email

This information is needed as soon as possible. The larger our base list the more invitations we can extend and the greater chance we have of reaching out to a number of major third party payers. All information can be forwarded to AngelaSBrooks@....

The names that you share will remain confidential and will not be shared with other members.

Thank you in advance for taking the time to be a part of this valuable project.

The VPTA Payer Relations Committee

This is a reminder that all HIPPA standard transactions are to be submitted utilizing NPI numbers by May 23, 2008 or claims will be denied. Below, please find a recent update from Trailblazer Health. Please take note of the statistics currently recorded for Virginia.

Please contact me with any questions. AngelaSBrooks@...

Angela S Brooks, PT

VPTA Payer Relations Specialist

-----------------------------------------------------------------------------------------------------

NPI

Only 51 days until May 23, 2008 – NPI mandatory for all HIPAA standard transactions. Avoid delays in Medicare payments!

NPI Submissions Received - As of March 29, 2008, the percentage of Part B claims submitted to TrailBlazer with NPI only are listed below. Be prepared! Test NPI-only claims NOW! As of May 23, 2008, claims received with legacy numbers will be rejected!

Part B:*

Colorado - 22.49%
DC/DE - 10.69%
Maryland - 19.07%
New Mexico - 17.97%
Oklahoma - 38.21%
Virginia - 12.35%
Texas - 6.05%

* Part A claims submission percentages will be shared as soon as they become available.

Part A & B:

May 23, 2008 – NPI Required on All HIPAA Standard Transactions
http://www.trailblazerhealth.com/Tools/Notices.aspx?DomainID=1&id=12362

Potential Issues Related to Clearinghouse and Billing Service Practices
http://www.trailblazerhealth.com/Tools/Notices.aspx?DomainID=1&id=12128

Medicare Policy on Subpart Designation
http://www.trailblazerhealth.com/Tools/Notices.aspx?DomainID=1&ID=12298

Part A:

Mandatory Reporting of the NPI on All Part A Claims
http://www.trailblazerhealth.com/Tools/Notices.aspx?DomainID=1&ID=12060

How to Update or Modify NPI Information
http://www.trailblazerhealth.com/Publications/Job%20Aid/HowtoUpdateorModifyNPI.pdf?DomainID=1

Part B:

NPI Billing Tips
http://www.trailblazerhealth.com/Publications/Job%20Aid/NPIBillingTips.pdf?DomainID=1

Provider Enrollment Part B NPI Issues
http://www.trailblazerhealth.com/Tools/Notices.aspx?DomainID=1&id=12352

Common NPI Errors
http://www.trailblazerhealth.com/Publications/Job%20Aid/CommonNPIErrors.pdf?DomainID=1

Common NPI Errors and Resolutions
http://www.trailblazerhealth.com/Publications/Presentation/NPICommonErrors.pdf?DomainID=1

New NPI Correction and Inquiry E-Mail Address
http://www.trailblazerhealth.com/Tools/Notices.aspx?DomainID=1&id=12303

NPI – March 1 Milestone
http://www.trailblazerhealth.com/Tools/Notices.aspx?DomainID=1&id=12301

NPI Tips for Success
http://www.trailblazerhealth.com/Publications/Job%20Aid/NPITipsforSuccess

If you have had customer service issues during rate negotiations with
ACN Group, please share with me specifics of these exchanges and I will
communicate the information to ACN. They are aware that some members
have not been pleased with the process and want to delve deeper into
this issue to improve customer service.

Thanks.

Angela S. Brooks, PT

VPTA Payer Relations Specialist

The following is a FAQ developed by ACN to address questions regarding the Clinical Support Program. I hope you find this helpful.

Angela S. Brooks, PT

VPTA Payer Relations Specialist

Q: Where may I obtain additional information about ACN Group's Clinical Support Program?

A: You may obtain additional information regarding ACN Group's Clinical Support Program by accessing your:

• ACN Group Plan Summary
• ACN Group website, WebAssist, www.acnprovider.com
• ACN Group Operations Manual
• ACN Group Member-Provider Service Representative for administrative information
• ACN Group Support Clinician for clinical information

Q: Who is my Support Clinician and how do I reach him/her to discuss clinical issues?

A: ACN Group has clinicians located throughout the United States.  Each state has a designated Support Clinician(s).  An ACN Group Member-Provider Service Representative may connect you with your assigned Support Clinician.  Additionally, your Support Clinician's name is listed on the Patient Summary Response you receive when you submit a Patient Summary Form to ACN Group.

Q: I hear about the ACN Group website/"my website"/WebAssist repeatedly.  How do I access this site and why should I use this site?

A: The ACN Group provider Web site, WebAssist, provides a wealth of information.  You may access WebAssist by launching Internet Explorer on your browser, typing www.acnprovider.com into the URL, and entering your ACN Group provider ID and Web site password.  If you do not have a provider ID and password, you may contact an ACN Group Member-Provider Service Representative who will provide you with one.

WebAssist  offers a variety of useful tools and information including:

• Your provider profile
• A direct link for submission of ACN Group Patient Summary Forms
• A  link to view Patient Summary Form submission status
• A link to view claim submission form status
• A link to submit a claim
• Clinical resources to include tutorials, commonly used forms, newsletters, and policies

Q: I am frequently encouraged to use the "online format" for Patient Summary Form submissions.  Why should I submit a Patient Summary Form online rather than submit it via facsimile?

A: One of the benefits of electronic Patient Summary Form filing is that the system will not accept the Patient Summary Form unless it is filled in completely. This will immediately reduce errors and process delays.  Facsimile submission of incomplete Patient Summary Forms can increase processing time.  Another benefit to submitting a Patient Summary Form online is that once the Patient Summary Form is successfully submitted you will receive a confirmation number.  You may print out the confirmation page or copy down the confirmation number.  Receipt of the confirmation number lets you know that your Patient Summary Form has been received by ACN Group.  When you submit your Patient Summary Form online, you have the added ability to view the status of your online submission.

Q: My office staff calls UnitedHealthcare for notification and/or preauthorization information.  They are frequently advised by UnitedHealthcare that notification and/or preauthorization are not required.  After initiating treatment and subsequently submitting claims for reimbursement, we sometimes learn that claims are denied due to non compliance with ACN Group's Clinical Support Program/Utilization Review requirements.  Does ACN Group communicate with UnitedHealthcare and visa versa?

A: All clinical submission requirement questions should be directed to ACN Group.  You may call the Quick Group Check line at 888-329-5182 or log onto www.acnprovider.com to check the Plan Summary and UnitedHealthcare group check link to verify the need for ACN Group clinical submission.  You should call UnitedHealthcare's customer service center for information regarding patient benefits.

Q: Why is my Patient Summary Form submission returned as "late"?

A: A Patient Summary Form submission is considered "late" if it is received later than 10 business days after the start of treatment.

Q: I am treating a patient with two different conditions.  When I submit a second Patient Summary Form for the second condition, the first Patient Summary Response is changed to reflect inclusion of the second condition.  Why can't I have a different Patient Summary Response for each condition treated?

A: ACN Group expects providers to treat all conditions identified judiciously and simultaneously.  If treatment begins with one condition within a given timeframe and ACN Group receives a new Patient Summary Form with a new condition identified, the end date on the initial notification response will be shortened to allow for the start date of the current Patient Summary Form submission.

Q: Why does my Patient Summary Response confirmation number contain letters in addition to the usual number-only confirmation?

A: A Patient Summary Response number that contains letters as a part of the confirmation number indicates that a change in the original Patient Summary Response has occurred.  Examples of when you may see this are as follows:

• Change/update in conditions treated
• Change/update in visit value
• Change/update in visit end date value

These types of changes typically occur as a result of additional information provided by your office.

Q: ACN Group does not require that I record functional outcome measures with each Patient Summary Form submission.  Why should I implement functional outcome assessment in my clinic and why should I submit functional outcome scores on the Patient Summary Form?

A: Using functional outcome tools in your clinic provides you with ongoing assessment of patient progress with the established treatment plan.  Sharing these outcomes with your patient is an opportunity for first-hand continuous feedback.  This also provides the strongest documentation for the ongoing need for skilled care.  All outcome assessment tools, templates, scoring how-to's, and interpretative education materials are available on the ACN Group Web site, www.acnprovider.com.

Q: Should I review the Patient Health Questionnaire with my patients?

A: Absolutely.  When you review the Patient Health Questionnaire with your patients, you improve patient/practitioner communication, goal setting, and barrier recognition.  The increase in communication can yield a more positive treatment outcome.

Q: Why should I include information about my patient's surgical procedure and the date of surgical procedure on the Patient Summary Form? 

A: Your designated Support Clinician reviews all relevant information in order to apply an appropriate visit/date milestone value to the Patient Summary Response.  Surgical procedure and date of surgical procedure information are important components of a patient's health record.  Recording these applicable components ensures that your Support Clinician has a full appreciation of the case and all the complexities that may exist due to surgical intervention.

Q: Should my office staff share with me a Patient Summary Response that reads "stationary" or "ineffective"?  Should I discuss this transitional type response with my patients?

A: A "stationary" or "ineffective" transitional response on the Patient Summary Response reflects a determination in which a lack of progress is appreciated based on the submitted documentation.  These response types should be shared with the treating practitioner, and they in turn provide an ideal opportunity for patient/practitioner discussion about treatment plan, goals, and barriers toward progress.  Additionally, should you recognize unique barriers to improvement, you should feel free to contact your assigned Support Clinician for discussion

Q: I have a contract reimbursement question.  Where should I direct my question/concern?

A: Contract/reimbursement concerns may be addressed in writing to:

ACN Group Network Management

PO Box 59329

The following information is from CMS and Trailblazer Health. Take note, the NPI is no longer optional....it is mandtory and claims will be denied with it.

The "Medicare Appeals Process: Five Levels to Protect Providers, Physicians and Other Suppliers" brochure has been updated and is now available for order via print copies or as a downloadable PDF file. To view the PDF file, go to http://www.cms.hhs.gov/MLNProducts/downloads/MedicareAppealsProcess.pdf ,  or to order hard copies, visit the MLN Product Ordering Page at http://www.cms.hhs.gov/MLNProducts/ . Scroll down to "Related Links Inside CMS" and select "MLN Product Ordering Page."

CMS just announced  a new interactive resource that answers questions about becoming a Medicare provider, billing, appeals, etc.  This resource is found at: 

http://www.cms.hhs.gov/apps/training/guidedpathways/guidedpathways.html

I have been informed that the LCD in effect for outpatient rehab providers of Medicare Part B recipients in VA will remain in the same format as 2007 without changes through June of 2008.

Everyone who sent in comments regarding the draft LCD, be assured your efforts were not in vain. The draft will be under consideration again this summer and your comments have been shared with the Ad Hoc Committee.

I will update you as I know more details. If you have any questions or comments, please email them to angelasbrooks@....

Thanks.

Form Name Change

ACN Group is changing the name of the "Notification Form" to "Patient Summary Form." The reason for this form name change is the term "notification" has taken on many different meanings since ACN first began to use this term in the late 1990s. This name change will more clearly distinguish the ACN utilization review process from "notification" processes of other entities. 

The contents of the form have not changed; only the name at the top of the form has changed.  The form submission process and requirements remain the same and are described in the Plan Summary for each health plan or program.  

While ACN Group will continue to process forms labeled "Notification Form" for the next several months we encourage you to obtain a copy of the "Patient Summary Form" at www.acnprovider.com and to begin using this form immediately. Subsequent communications will describe when use of the "Patient Summary Form" will be required and the "Notification Form" will no longer be accepted.

NGS (National Government Services) functions as the FI for VA Medicare policies. They have recently released a draft LCD that will be utilized as a review tool for outpatient therapy services provided by facilties.

The draft LCD has a comment period during which input is accepted and considered as the final format of the document is crafted. Providers in VA are encouraged to review this document and comment as appropriate. Any input will be shared with the APTA to be merged into a letter that will be sent to the Medical Director of NGS.

You may access the draft by going to:

http://www.empiremedicare.com/newypolicy/draft/dl26884_draft_lcd.htm

As you look over this document, a few things that you may want to direct your comments to are: the definition of physical therapist and physical therapist assistant and modified recertification requirements defined in the 2008 Medicare Fee Schedule final rule; exclusion of services provided by students as covered services; wound care coverage limitations, non-covered services of iontophoresis, and vestibular ocular reflex training.

This list is not exhaustive and you are encouraged to examine the LCD and make any comments you deem appropriate.

All comments can be sent to my attention at angelasbrooks@....

I need your comments no later than 2/28/2008. 

Thanks.

Angela S.Brooks,PT

VPTA Payer Relations Specialist

As many of you know, ACN Group, Inc manages a portion of the physical therapy claims review for products offered by United Health. In August 2007 the VPTA was invited by ACN to come to the table to offer input on various aspects of their utilization mangement policies as well as many other operational processes that impact physical therapists in Virginia.

On February 21st, the VPTA will again meet with ACN and have the opportunity to discuss  issues that impact therapists in Virginia. I will serve as the representative for Virginia and requst that you communicate with me any information that you would like relayed to ACN.

Based on previous meetings with ACN, I ask that you consider the following as you craft your comments. This list is in no way exhaustive and I am open to any and all input that you are willing to offer.

1. Do you understand the notification process? Do you know what this is?

2. Do you know your tier status? Do you know what this is?

3. Do you use online tools to complete necessary paperwork?

4. Is turn-around time to obtain initial and ongoing visits adequate?

5. Are adequate visits allowed to address patient needs? Are procedures in place     to  address outliers?

6. Are there policies or procedures that are supported by ACN that you find helpful?

Thanks in advance.

Angela S. Brooks, PT

VPTA Payer Relations Specialist

AngelaSBrooks@...

Many of you have been kind enough to attempt to access the draft LCD however have been unable to do so based on an error in my previous posting.

Please see the draft LCD at http://www.trailblazerhealth.com/Tools/Local%20Coverage%20Determinations/Default.aspx?id=2962&DomainID=4

If you continue to have difficulty please let me know.

Regards,

Angela S. Brooks, PT

VPTA Payer Relations Specialist

Medicare has released a draft LCD and your comments are needed. VA is again participating with several other states impacted by TrailblazerHealth, LLC to craft commentary to be considered as the "go-live" date of this LCD nears ( 3/1/2008).

Please look over the document, in particular the crosswalk ( titled "Limited Coverage Attachment), and give any comments you deem helpful. In making your comments references to clinical scenarios are always useful.

I NEED THIS INFORMATION AS QUICKLY AS POSSIBLE SUCH THAT IT CAN BE ADDED TO OTHER COMMENTS AND FORWARDED TO TRAILBLAZER HEALTH.

C:\Documents and Settings\Angela\Local Settings\Temporary Internet Files\Content.IE5\ISVRAY09\LCD Draft TrailBlazerHealth.com.mht

Thanks in advance for your support.

Angela S. Brooks, PT

VPTA Payer Relations Specialist

PRESIDENT SIGNS THE MEDICARE, MEDICAID AND SCHIP EXTENSION ACT OF
2007 (S. 2499)


On Saturday, President Bush signed The Medicare, Medicaid and SCHIP
Extension Act of 2007 (S. 2499).

Several provisions important to physical therapists and their
patients were in the final bill including:

Extension of the therapy cap exceptions process through June 30,
2008.
Increase in physician payment update; extension of the physician
quality reporting system. Replaces the scheduled 10.1% cut to the
Medicare physician reimbursement rate in 2008 with a 0.5% increase
through June 30, 2008.
Extension of the floor on work geographic adjustment.  Extends for
six months the work geographic index (GPCI) floor of 1.0 through
June 30, 2008.
Payments for Inpatient Rehabilitation Facility (IRF) Services.
Permanently freezes the inpatient rehabilitation services compliance
threshold at 60%.  Sets the market basket update factor at 0% from
April 1, 2008 through FY09.
Reauthorization of SCHIP to March 2009.

CONGRESS PASSES THE MEDICARE, MEDICAID AND SCHIP EXTENSION ACT OF 2007 (S. 2499) 

Congress has approved legislation postponing the Medicare therapy cap and scheduled cuts to the physician fee schedule.

Lawmakers on Wednesday sent to the president legislation extending the therapy cap exceptions process and implementing a 0.5% positive update in the fee-schedule conversion factor until June 30, 2008. President Bush is expected to sign this legislation into law.

The Medicare, Medicaid, and SCHIP Extension Act of 2007 (S 2499) contains several provisions important to physical therapists and their patients, including:

Extension of the therapy cap exceptions process through June 30, 2008.
Increase in the physician payment rate and extension of the physician quality reporting initiative (PQRI). Replaces the scheduled 10.1% cut to the Medicare physician reimbursement rate in 2008 with a 0.5% increase through June 30, 2008.
Extension of the floor on work geographic adjustment. Extends the work geographic index (GPCI) floor of 1.0 through June 30, 2008.
Payments for inpatient rehabilitation facility (IRF) services. Permanently freezes the IRF services compliance threshold at 60%. Sets the market basket update factor at 0% from April 1, 2008, through FY09.
Reauthorization of SCHIP to March 2009.

Visit the Therapy Cap Resource Center on www.apta.org/advocacy .

 American Physical Therapy Association - 1111 N. Fairfax Street, Alexandria, VA, 22314. 800-999-APTA (2782).

 CMS Final Fee Schedule Rule issued November 1, 2007 will go into effect on January 1, 2008. I recommend visiting the APTA website to obtain a comprehensive explanation of the changes defined in the rule. You will also be directed in how you can make a difference in the future of our profession by voicing your opinion relative to many issues that can still be changed.

http://www.apta.org/AM/Template.cfm?Section=Medicare1&Template=/TaggedPage/TaggedPageDisplay.cfm&TPLID=338&ContentID=44109

 Of note:

- The 2008 fee schedule for physical therapy services will have an impact of -9% in aggregate. Be aware there are a number of parameters that figure into this overall number.

- There are new definitions of Physical Therapist and Physical Therapist Assistant.

- CMS acknowledges that it may explore plans to helpf curb abusive in-office ancillary services arrangements in the future. ( RFP)

- Updates to policies for payment for services rendered in a CORF.

- Pay for Performance parameters for reporting increased - 6 measures could apply to physical therapists.

- The Therapy Cap will be in place for 2008 with an increase from $1780.00 combined PT/ST benefit in 2007 to $1810.oo.

-The  Therapy Cap Exceptions process will end January 1, 2008 unless Congress acts.

- The Medicare recertification process has been extended from 30 days to 90 days.

- etc.

Once you have accessed the APTA website, please feel free to contact me with any questions.

Angela S. Brooks, PT

VPTA Payer Relations Specialist

AngelaSBrooks@...

The following information was forwarded via the Trailblazer Listserv. NPI numbers, although intended to streamline and simplify, may cause problems if not utilized appropriately. Please review the following.

Thanks.

Angela S. Brooks, PT

VPTA Payer Relations Specialist

______________________________________________________________

Important Information for Medicare Providers

For physicians and non-physician practitioners who bill Medicare – Your Medicare carrier has contacted, or will be contacting you, about the date Medicare will begin rejecting your claims if the NPI and legacy number pairs used on Medicare claims are not compatible. If billing using only the NPI, please skip to the last paragraph.

Some incorporated physicians and non-physician practitioners have obtained NPIs as follows: an individual (Entity Type 1) NPI for the physician or non-physician practitioner and an organization (Entity Type 2) NPI for the corporation. If you enrolled in Medicare as an individual and obtained a Medicare Provider Identification Number (PIN) as an individual, and want to use the NPI and the PIN pair on Medicare claims, be sure to use the individual NPI with the individual PIN. Pairing the corporation's NPI with the individual PIN will result in claims being rejected. If you wish to bill Medicare with the corporation's NPI, ensure the corporation is enrolled in Medicare so that it can be assigned a PIN. Contact the Medicare carrier for more information about this enrollment. Until the corporation has been enrolled in Medicare, you may continue to bill by using the individual NPI with the individual PIN to ensure no disruption in claims being processed and paid. Please note that similar problems may result if you bill Medicare by using the individual NPI with the corporation's PIN (if the corporation is enrolled and has been assigned a PIN). When billing with the NPI/PIN pair, you must use compatible NPIs and PINs.

NPI–Only Billers: Ensure the NPI you are using is compatible with your Medicare enrollment. For example, if enrolled in Medicare as an individual, you should be using an individual (Entity Type 1) NPI.

Trailblazer Health Enterprises, LLC hosts a number of educational activities via a variety of avenues included teleconference and web-based training.

Those interested in finding out more should explore the classes offered and register though the TrailBlazer Website "Calendar of Events." 
http://www.trailblazerhealth.com/calendar/default.aspx?DomainID=1

Thanks.

Angela S. Brooks, PT

VPTA Payer Relations Specialsit

The following information was sent via the Trailblazer Listserv. Please review this information to assure that your practice setting is fully aware of all current requirements surrounding the NPI.

Thanks,

Angela S. Brooks, PT

VPTA Payer Relations Specialist

____________________________________________________________________

Part B Only: Updated - How to Use Your NPI When Billing Medicare – Effective Monday, October 8, 2007, TrailBlazer will begin rejecting NPI/Legacy ID combinations that do not match on the NPI crosswalk file.

How Do I Share My NPI With Medicare? – Please share your NPI with Medicare by submitting it on Medicare claims. Unlike some health plans, there is no fax number, telephone number or special Web site providers need to use to communicate their NPI to Medicare. As stated previously, Medicare is now asking that submitters send a small number of claims using only the NPI. If no claims are rejected due to provider legacy number errors, the submitter can gradually increase the volume. More information about NPI is available on the TrailBlazer NPI Web page.

Important – Providers Should Submit Both NPIs and Legacy Numbers on Medicare Claims – Until further notice, providers should submit both NPIs and legacy provider numbers on Medicare claims to ensure they are properly processed.

ACN Group, Inc currently provides physical therapy and chiropractic utililization management and claims processing for UnitedHealth Group. Recently I attended a meeting with ACN  in Minnesota. The purpose of this meeting was to learn more about ACN's utilization management tools and to assist ACN  in better understanding what physical therapy providers need and want to ease the process of doing business and to foster the best possible outcome for the patient.

 If you have any information regarding your experiences with doing business with ACN, I welcome your comments.

It is only through your input that I can fully understand the impact that ACN's current business practices are having in Virginia and in turn articulate that information to ACN.

ACN is making an attempt at improving communication with providers via remodeling their current provider portal. As of August 27th the new tools will be in place to allow your to view notification update reminders and a message center.

Thanks in advance for your input.

Angela S. Brooks, PT

VPTA Payer Relations Specialist

AngelaSBrooks@...

Please review the following information.

• CMS is delaying the launch of the NPI Registry and the dissemination of FOIA-disclosable health care provider data from the National Plan and Provider Enumeration System (NPPES). 

• Some providers are having increased denials secondary to clearinghouses stripping the NPI number from their claims. You are advised to contact your clearinghouse to assure that this is not causing increased denails for your office.

• Submit Medicare claims with NPI and legacy numbers. At this point the process is still quite new and the legacy facilitates appropriate processing.

• A mass adjustment for the KX modifier denials has been initiated as of July 16th for VA.  Claims with the KX modifier should process appropriately now.

• The "Five State Ad-Hoc Committee" that has been referenced numerous times on this listserv received notice from Traiblazer Health that they are not going to retire the procedure to diagnosis crosswalk as requested. They are, however, willing to discuss specific diagnosis/procedure omissions in the crosswalk of which there are many.

• Trailblazer Health has modified their website. Check it out!

Please contact me at angelasbrooks@... if you have any questions regarding the information posted here. Also, you are encouraged to register for the listserv on the Trailblazer website. This can be accomplished by going to www.trailblazerhealth.com and selecting listserv.

Thanks.

Angela S. Brooks, PT

VPTA Payer Relations Specialist

Call for Abstracts
VPTA 2007 Annual Conference

The VPTA Research Committee is currently accepting abstracts for
consideration for poster and platform presentations at the 2007
Annual Conference, October 19-21, 2007 in Roanoke, Virginia.

Poster Presentation Categories (taken from the APTA call for
abstracts)
„« Research Report
„X Presents original scientific data collected by the author(s);
any established research format, both experimental and
nonexperimental designs, may be used (e.g. clinical trials,
descriptive studies, single-subject designs, qualitative methods,
etc.)
„« Special Interest Report
„X Presents unique and innovative concepts, ideas, devices, or
products developed to meet the special needs of physical therapy;
ways in which these reports can be expressed include case reports,
case studies, and reports of projects
„« Theory Report
„X Presents a theory, idea, concept, or model that describes a
foundation for the practice of physical therapy.  For additional
information on theory, see Krebs DE, Harris SR. Elements of theory
presentations in physical therapy. Phys Ther. 1988;68:690-693.

Platform Presentation
„« Case-Based Clinical Reasoning Report
„X Presents a patient case using the Guide to Physical Therapy
Practice terminology that explores the clinical reasoning used for
the examination, evaluation, diagnosis, prognosis, interventions, and
outcomes choices that were made in the management of the patient;
informs the audience about clinical decision making skills that were
supported by current best evidence-based practice


Submission Guidelines

Presentation Format
Poster Presentation:  Reports are summarized on a large poster board
(3¡¦ x 6¡¦) using concise and easily readable text to present the key
components of the project.  Posters are set up in one room and will
be on display for a set time during the conference.  Authors will
have an assigned time block to stand with the poster and answer
questions from participants who are walking through the poster
presentation area.

Platform Presentation:  A 50-minute oral presentation to a seated
audience with a moderator present to facilitate questions; 30 minutes
for the author¡¦s presentation and 20 minutes for questions from the
moderator and audience.

Abstract Format
Research Report must include the following information/subheadings:
Purpose, Background/Significance, Subjects, Methods and Materials,
Analyses, Results, Conclusions, Funding Source

Special Interest Report must include the following
information/subheadings unless it is a case study/report:
Purpose, Foundation (What is the underlying basis for the report?),
Description (What methods, materials, and principles did the project
involve?), Observations, Conclusions, Funding Source

For the case study/report, the following information/subheadings must
be includes:
Background and Purpose, Case Description, Outcomes, Discussion

Theory Report must include the following information/subheadings:
Theory (Describe the theory, idea, concept, or model), Phenomenon
(Describe the phenomenon the theory proposes to explain, predict, or
describe), Purpose (What is the major reason for developing the
theory presented?), Evidence (Briefly summarize the evidence or
experience that supports the theory), Testable Hypotheses (Give
examples of testable hypotheses or propositions derived from the
theory, idea, concept, or model), Importance (What is the importance
of the theory to physical therapy?), Funding Source

Case-Based Clinical Decision Making Report must include a description
of the patient case and a discussion of how clinical decision making
skills and current best evidence supported the management of the
patient

Abstract Submission Deadline is August 15, 2007

Submission Requirements
Submit one copy of the abstract electronically to the research chair
with information identifying the author(s) and contact person.
Please indicate if the abstract is for the poster or platform
presentation.  The electronic file must be compatible with Microsoft
word.

Note:  A ¡§blinded¡¨ copy of the abstract will be used for review by
the committee.  For all accepted presentations, the abstract with
author identifying information will be posted on the VPTA website as
a public acknowledgement of the presentation.

Evaluation and Selection of Abstracts
The VPTA Research Committee peer reviews all abstracts.  Abstracts
are selected on the basis of compliance with the content and format
requirements, intelligibility of the abstract, and the importance of
the information as it relates to physical therapy.  Abstracts may be
returned to authors for revision prior to final acceptance.

Notification
Notification of the committee¡¦s decision will occur via email no
later than September 20, 2007.

Presentation Times and Date
All presentations are made on Friday afternoon, October 19, 2007
between approximately 4:00 and 5:30 pm.


Contact Cathy S Elrod, PhD, PT with any questions or concerns at 703-
284-5984 or cathy.elrod@...

This information appeared in PT Bulletin Friday, June 22nd.  In case
you did not review the information, please take note.  It is
important to review your NPI data to make sure that personal
information such as your social security number is not displayed.

NPI Information Going Public June 28

Physical therapists who have applied for their National Provider
Identifier (NPI) should check the accuracy of their information and
delete optional data they do not want released before it is made
public on June 28. To check the information, log on to the National
Plan and Provider Enumeration System Web site
(https://nppes.cms.hhs.gov/NPPES/Welcome.do) or call 800/465-3203.
Provider data will be downloadable from the CMS Web site
(http://www.cms.hhs.gov/NationalProvIdentStand/) and available in a
database allowing users to query by NPI or provider name. Inaccurate
information in the database could have billing implications and
result in delays. NPIs, entity type codes, provider names, and
addresses will be available online. Social Security numbers,
individual taxpayer identification numbers, and dates of birth will
not be disclosed. Information submitted in optional fields, however,
will be published. Sensitive information, such as Social Security or
prescription drug numbers, should not be included in these fields.
For instance, other legacy identifiers should only include billing
numbers, such as the unique provider identifier (UPIN) or the
National Supplier Clearinghouse (NSC), not Social Security numbers.

This is to remind all of you that Medicare will implement the PQRI program on July 1, 2007. The PQRI bonus of 1.5% is available to all PT's in private practice treating Medicare beneficiaries.

You can obtain more detailed information on this program at: http://www.apta.org/AM/Template.cfm?Section=Coding_Billing&TEMPLATE=/CM/ContentDisplay.cfm&CONTENTID=38481

It is of note that although facility based therapists are not included in this program at this time, the APTA is in discussion with Medicare to explore the possibility of future program modification.

Thanks.

Angela S. Brooks, PT

VPTA Payer Relations Specialist