Everyone - The following was sent out by Trailblazer Health and is intended for Part B providers only.

______________________________________________

The Provider Outreach and Education department will be traveling to three Virginia locations to conduct education on an assortment of topics that are sure to assist the provider community with their Medicare billing needs.

This tour is an excellent opportunity to meet the education staff, gain Medicare Part B knowledge and acquire printed training materials that will benefit providers and their billing staff. Each one-day session will allow each participant to attend all six of the offered topics for a nominal fee. Registration for these events is mandatory and space is limited.
http://www.trailblazerhealth.com/Calendar/Default.aspx?id=422&DomainID=1

Medicare Provider Feedback Town Hall Meeting
October 29, 2009
2–4 p.m. ET

CMS requests your participation in a Town Hall meeting on October 29, 2009, 2-4
p.m. ET. The meeting will be held via conference call as well as in the
auditorium at the Centers for Medicare & Medicaid Services, 7500 Security
Boulevard, Baltimore, Maryland 21244.

The purpose of the meeting is to capture individual provider feedback on
relevant Fee-for-Service (FFS) Medicare policy and operational issues and, by
doing so, advance CMS' efforts to enhance its relationship with providers and
suppliers. This Town Hall meeting also provides a venue to allow CMS staff to
engage individual providers and suppliers through the following year. This
meeting is open to all Medicare FFS providers and suppliers who participate in
the Medicare program.

The agenda topics are available on the registration page. Meeting agenda and
discussion materials will be available to download at
http://www.cms.hhs.gov/center/provider.asp by October 23, 2009. CMS will conduct
a discussion session at the meeting that offers meeting participants an
opportunity to provide feedback on agenda topics.

Note: Due to time constraints, not all participants will have an opportunity to
speak, but written submissions will be accepted at MFG@... through
November 6, 2009. CMS will give consideration to feedback received, but written
responses will not be provided.

Meeting Registration Details
All participants must pre-register for the meeting through online registration
at http://registration.intercall.com/go/cms2. Registration will open September
28, 2009, and will close October 23, 2009. Registered participants may be
contacted for follow-up meetings to solicit additional individual opinions and
clarify any issues that may arise during the October 29 Town Hall meeting.

Upon registering, you will receive a confirmation page to indicate the
completion of your registration. Please print this page as your registration
receipt. It is recommended that you complete your registration as soon as
possible. Registration after 5 p.m. October 23, 2009, will not be accepted.

Meeting Participation Details
All participants attending the meeting in person will be required to show a
photographic identification (a valid driver's license or passport). Further
details can be found in the September 25, 2009 Federal Register notice. All
persons participating via conference call will receive dial-in information with
their confirmation e-mail.

Additional Questions/Information
For questions or additional information about the Medicare Provider Feedback
Town Hall Meeting, please send an e-mail to MFG@....

Everyone - Earlier today, I reminded you of the upcoming deadline for public comment on recent DMAS billing regulation changes. Below, please find a letter from the VPTA to DMAS regarding this issue.

Angela S. Brooks,PT

VPTA Payer Relations Specialist

___________________________________________________________________________________________________

September, 2009

Department Of Medical Assistance Services (DMAS)
600 East Broad Street

Richmond, VA 23219

Dear Sir or Madame:

The Virginia Physical Therapy Association (VPTA) respectfully requests a reconsideration of the Department of Medical Assistance Services' determination limiting the CPT codes available to physical therapists for claims submission. This policy is problematic as it creates additional financial and administrative burdens for physical therapists. In addition, it does not adequately reflect the scope of practice of physical therapists and the services they deliver. It violates the standards of practice physical therapists utilize to ensure that the services billed are supported by the documentation in the patient's medical record. Finally, it is inconsistent with the billing practices of other insurers, including Medicare.

As the policy stands, physical therapists would be required to bill the Department for all physical therapy services provided to the state's Medicaid beneficiaries using a small subset of CPT codes. Specifically these codes are 97001 (PT evaluation), 97110 (therapeutic exercises), and 97150 (therapeutic procedures, group). Physical therapists typically bill for their services utilizing codes in the 97000 series as well as select other codes outside this series as provided by the American Medical Association in the CPT 2009 coding manual[1].

For example, CPT code 97110, therapeutic exercise is defined in the CPT Manual as "Therapeutic procedure, one or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility." Compare this to another intervention, wound care, within the scope of practice of physical therapists. CPT code 97597 is described in the CPT manual as "Removal of devitalized tissue from wound(s), selective debridement, without anesthesia (eg, high pressure waterjet with/without suction, sharp selective debridement with scissors, scalpel, and forceps), with or without topical application(s), wound assessment, and instruction(s) for ongoing care, may include use of whirlpool, per session; total wound(s) surface area less than or equal to 20 square centimeters."

CPT code 97110 does not at all describe or could not be considered applicable to a CPT code used to describe services associated with wound care. To expect that physical therapists would be able to adequately capture the services they provide and appropriately document the medical necessity of those services by using only three codes is unreasonable and does not comport to professional standards of practice. In fact, to report one service as another, in this scenario wound care as therapeutic exercise, would be considered fraudulent under all other insurer policies.

The professional standards of practice developed by APTA dictate that at each visit or encounter the following pieces of information are included in the medical record:

·                                Documentation of each visit/encounter shall include the following elements:

o                                           Patient/client self-report (as appropriate).

o                                           Identification of specific interventions provided, including frequency, intensity, and duration as appropriate. Examples include:

·                                                       Knee extension, three sets, ten repetitions, 10# weight

·                                                       Transfer training bed to chair with sliding board

·                                                       Equipment provided

o                                           Changes in patient/client impairment, functional limitation, and disability status as they relate to the plan of care.

o                                           Response to interventions, including adverse reactions, if any.

o                                           Factors that modify frequency or intensity of intervention and progression goals, including patient/client adherence to patient/client-related instructions.

o                                           Communication/consultation with providers/patient/client/family/ significant other.

o                                           Documentation to plan for ongoing provision of services for the next visit(s), which is suggested to include, but not be limited to:

·                                                       The interventions with objectives

·                                                       Progression parameters

·                                                       Precautions, if indicated

Physical therapists document the specific interventions they provide at a given encounter for several important reasons. It is important that the therapist has a record of services provided to ensure that the most appropriate services are being rendered to a patient. If all services were recorded as therapeutic exercise, it would not give an accurate picture of the patient's condition and needs or the interventions provided.  

In 2000, the Department of Health and Human Services (HHS) designated the CPT codes as the national coding standard for physician and other health care professional services and procedures under the Health Insurance Portability and Accountability Act (HIPAA). This means that for all financial and administrative health care transactions sent electronically, the CPT code set will need to be used. In fact, payers including Medicare and private insurers have adopted the 97000 series codes as those appropriate to bill for reimbursement of physical therapy services. By limiting physical therapists to three codes, DMAS is establishing a payment system in direct contradiction with Medicare and other federal healthcare programs.

Therefore, we strongly urge DMAS to retract its policy which limits physical therapists to documenting for services using only the three delineated CPTs codes, as mentioned above, and to mandate a new policy which clearly states that physical therapists are permitted to use the full scope of the CPT 97000 series and other CPT codes as needed per their clinical judgment to adequately and appropriately document medical necessity of physical therapy services delivered to patients under the Virginia Medicaid program.

We thank you for your time and consideration and would be more than happy to lend our expertise in this area, if further information is needed.

July 7, 2009

TrailBlazer Health Enterprises® is issuing this listserv to notify the Part A
and B community of important updates concerning Electronic Data Interchange
(EDI) services.

Please share this listserv with others in your organization who would benefit
from receiving timely and accurate Medicare information. Instructions to join
the TrailBlazerSM general and specialty listservs are linked for their
reference.


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



Part B Claims Incorrectly Deleted Prior to Processing



On June 30, 2009, the Part B Multi-Carrier System (MCS) contained an invalid
National Provider Identifier (NPI) crosswalk file, which caused claims to be
deleted incorrectly. These claims require resubmission by providers. TrailBlazer
will be loading Batch Control Listings (BCLs) into the provider's electronic
mailbox to assist with indentifying the affected claims. The BCL is a listing of
claims that have passed editing in TrailBlazer's front-end processing system
(Gateway Production Network (GPNet)), but have been deleted prior to submission
to the Part B MCS for processing. An updated GPNet Communications Manual with
the file name has been loaded to the TrailBlazer Web site.



When providers receive the BCL for June 30, 2009, please rebatch these claims
and retransmit the files. These files should include claims that were submitted
to TrailBlazer from June 27–29, 2009. Safeguards have been established within
the Part B MCS to prevent this issue from occurring in the future.



Note: If you have been contacted by TrailBlazer Electronic Data Interchange
(EDI) and have already resubmitted the affected claims, please do not resubmit
the claims again.



We regret any inconvenience this issue has caused providers.

Red Flag Rules

The Federal Trade Commission just announced that it will delay enforcement of the new "Red Flags Rule" until August 1, 2009, to give creditors more time to develop and implement written identity theft prevention programs. The FTC announcement of the delay until August is available at: http://www.ftc.gov/opa/2009/04/redflagsrule.shtm

Medicare Withholding Tax:  Request for Information

For-profit health care entities, such as physical therapist private practices, physician practices, and hospitals, may be subject to a 3% withholding tax after December 31, 2011, if the entity receives a single payment of $10,000 or more from the government for services.  Certain payments are exempt from the withholding requirement, including Medicaid payments.  However, Medicare and Tricare payments that involve a single payment amount of greater than $10,000 are subject to the withholding.  Further clarification is needed regarding the $10,000 threshold determination.  Health care professional organizations are strongly advocating for an exemption for this requirement.

APTA is examining the potential impact of this provision on physical therapy and is seeking your assistance.   If your practice or facility ever receives aggregated payments of $10,000 or more from Medicare or Tricare, please send this information to nancywhite@... .  This information will help APTA determine possible action related to this matter.  Thank you for your help. 

On May 1, 2009 healthcare providers will be required to comply with Red Flag Rules established by the Federal Trade
Commission requiring that an Identity Theft Detection, Prevention and Mititgation Program be established. 

Information to assist you in assuring compliance has been crafted by the APTA and can be accessed using your member ID number at http://www.apta.org/AM/Template.cfm?Section=Fraud_and_Abuse&Template=/MembersOnly.cfm&ContentID=57432

You are encouraged to assure that your practice is in compliance with this regulation. The APTA not only has provided valuable explanatory information regarding the Red Flag Rules and identity theft protecection but also links offering sample policy and procedure documents.

If you need additional information, please contact me at AngelaBrooks.PT@....

Everyone - The following updates were provided by Trailblazer Health via the electronic provider bulletin.

______________________________________________________________________________________________

• Therapy Cap Exceptions Update

http://www.trailblazerhealth.com/Tools/Notices.aspx?DomainID=1&ID=12980

• Medicare CCI Edits quarterly update

http://www.trailblazerhealth.com/Tools/Notices.aspx?DomainID=1&ID=12997

• Medical Necessity Denials

http://www.trailblazerhealth.com/Tools/Notices.aspx?DomainID=1&ID=13008

• DMEPOS Supplier Accreditation Info

http://www.trailblazerhealth.com/Tools/Notices.aspx?DomainID=1&ID=13002

• Upcoming Part B Provider Education

http://www.trailblazerhealth.com/Tools/Notices.aspx?DomainID=1&ID=13006

• Stay in the loop! Sign up for Trailblazer electronic bulletins and listserv.

http://www.trailblazerhealth.com/Tools/Notices.aspx?DomainID=1&ID=11876

Part B Virginia Welcome to Medicare Part I Web-Based Training
February 12, 2009
The "Welcome to Medicare" series of Web-based sessions are intended for providers and their staffs who are new to the Medicare program and are interested in understanding Medicare rules and billing requirements. Part I includes information on how to begin billing Medicare, the importance of patient screening at the provider's office, and understanding the MSP rules and billing requirements.
http://www.trailblazerhealth.com/calendar/EventRegistration.aspx?id=607&DomainID=1

Part B Virginia Welcome to Medicare Part II Web-Based Training
February 18, 2009
Part II of this series will include details on submitting claims to Medicare, and reading and understanding the Medicare remittance advice.
http://www.trailblazerhealth.com/calendar/EventRegistration.aspx?id=602&DomainID=1

PQRI ( Physican Quality Reporting Initiative) in short is a program sponsored by Medicare to encourage eligible providers via financial incentive to report on various quality measures.

• Below, please find information on PQRI from Medicare. By utilizing the link you may view providers by location who participated in the PQRI program. Interestingly there were 1,156 therapists listed.

CMS Posts PQRI Reporting Information on CMS Web Site – Beginning December 19, 2008, the names of physicians and other health care professionals who reported quality information under the PQRI in 2007 will be available at http://www.medicare.gov\physician, the "Physician and Other Healthcare Professional Directory" located on the Medicare Web page at http://www.medicare.gov. This information includes all eligible professionals identified by their National Provider Identifier (NPI) who submitted at least one quality data code on their Medicare claims for services furnished during July 1, 2007, through December 31, 2007.

• The APTA will be sponsoring an audio conference on PQRI 2009. See below for more information.

PQRI in 2009: 2.0% Bonus Payment for Physical Therapy
1.5-Hour Live Audio Conference
Thursday, January 29, 2009
2:00 pm-3:30 pm (EST)

Registration closes midnight EST Friday, January 22 or as soon as all available spaces are filled!

Learn more at : http://www.apta.org/AM/Template.cfm?Section=Audio_Conferences1&CONTENTID=53543&TEMPLATE=/CM/ContentDisplay.cfm

 The following is from the Trailblazer Health website. Virginia providers will hear more from Trailblazer and Palmetto as the transition progresses.

 Palmetto Government Benefits Administrators, LLC (Palmetto GBA) has been awarded a contract for the combined administration of Part A/Part B Medicare claims payment in Jurisdiction 11 comprised of North Carolina, South Carolina, Virginia and West Virginia. Palmetto GBA has its operational headquarters in Columbia, S.C., with some operations performed in Columbus, Ohio. Palmetto GBA's website is http://www.palmettogba.com/palmetto/palmetto.nsf/SiteHome?ReadForm.

Everyone - my apologies.

My new email address for VPTA issues is

AngelaBrooks.PT@....

Sorry for the confusion.

Angela S. Brooks, PT

Everyone - Happy 2009!

In an effort to streamline your communications to me, I have a new email address that will allow me to more easily access VPTA related messages.

The new address is: AngelaSBrooks.PT@....

This change is effective immediately.

Angela S. Brooks,PT

VPTA Payer Relations Specialist

Applies to Part B Virginia providers only

Part B Virginia On the Radar – CERT WBT
January 15, 2009
This session will focus on data analysis of the Virginia CERT initiative. There will be an overview of errors identified based on CERT audits as well as specific information on consultations and new and established patient office and outpatient visit codes. This is a great opportunity for practices to learn from other providers' mistakes and take actions to ensure they are compliant with Medicare regulations.
http://www.trailblazerhealth.com/calendar/EventRegistration.aspx?id=603&DomainID=1

The following information was supplied by TrailblazerHealth.

ICD-10-CM/PCS National Provider Conference Call – Other Part A and Part B providers may register for the CMS ICD-10-CM/PCS national provider conference call that will be conducted November 12, 2008, from 12:30–2:30 p.m. ET. To register for the call, go to http://www.cms.hhs.gov/icd10/Downloads/ICD10_otherproviders.pdf. Registration will close at 12:30 p.m. ET on November 11, 2008, or when available space has been filled. To find additional information about this conference call and to access the ICD-10 Overview Presentation that will be discussed during the call, go to http://www.cms.hhs.gov/ICD10/07_Sponsored_Calls.asp.
(200811-10)

2009 Physician Fee Schedule Final Rule

The following information was supplied by the APTA. The link will provide a high level summary of the details of the final rule released at the end of October.

http://www.apta.org/AM/Template.cfm?Section=Home&TEMPLATE=/MembersOnly.cfm&DIRECTLISTCOMBOIND=D&CONTENTID=52802&NAVMENUID=2982

ICD-10 Codes

The information contained in the link below has been supplied by the APTA in an attempt to summarize proposed changes in current diagnostic coding methodology as well as predict the impact that these changes will have on the healthcare industry as a whole.

http://www.apta.org/AM/Template.cfm?Section=Coding_Billing&Template=/MembersOnly.cfm&NavMenuID=3037&ContentID=52582&DirectListComboInd=D

I am available to you to assist in answering any questions regarding this information.

Angela S. Brooks,PT
VPTA Payer Relations Specialist

AngelaSBrooks@...

Online Claim Status and Eligibility Inquiry Web-Based Training
December 9, 2008
The Professional Provider Telecommunication Network (PPTN) is a service TrailBlazer offers to Medicare Part B providers who submit claims electronically. PPTN allows the provider quick and easy access to information such as Medicare beneficiary eligibility, claim status information, summary of claims volume, summary of payments, pricing information, and diagnosis and procedure code lookups.
http://www.trailblazerhealth.com/calendar/EventRegistration.aspx?id=578&DomainID=1

PQRI Web-Based Training
December 10, 2008
This Web-based training session will provide an overview of the Physician Quality Reporting Initiative (PQRI) program, including an introduction to PQRI, 2007 PQRI status, incentive payments, feedback reports, 2008 PQRI program overview, successful reporting requirements, 2009 PQRI program overview and educational resources available.
http://www.trailblazerhealth.com/calendar/EventRegistration.aspx?id=582&DomainID=1

Provider Enrollment Application Tips Web-Based Training
December 17, 2008
Want to know more about the provider enrollment process and understand the complexities of the application? Attend this training session to learn more about the various types of enrollment applications, common application submission errors, reasons for returned applications, and various tips and reminders to avoid enrollment delays.
http://www.trailblazerhealth.com/calendar/EventRegistration.aspx?id=580&DomainID=1

----- Original Message -----

From: payerrelationsspecialist

To: vpta@yahoogroups.com

Sent: Friday, October 31, 2008 4:01 PM

Subject: [vpta-listserv] Compliance - Learn More!

The APTA will conduct an audio seminar on compliance issues in November.This will be a great opportunity for members to become more versed on this vital issue.

 

 

"Remaining Compliant: What PTs Need to Know"

1.5-Hour Live Audio Conference
Wednesday, November 19, 2008
2:00 pm–3:30 pm, Eastern Standard Time

Hurry—Registration closes midnight EST Friday, November 14 or as soon as all available spaces are filled!

APTA Members and Life Members: $89
APTA Members' Office Managers (must be registered by the APTA member): $89
Nonmembers: $159. No group rates are available.

Each registrant will receive a CD-ROM of the audio conference to be mailed in December 2008.

If you can't participate live in "Remaining Compliant: What PTs Need to Know", you may purchase the CD-ROM (Product ID# AV-52VP), which includes the audio conference recording and handouts, all for the same price as the LIVE seminar, available in December 2008. Member price: $89; Nonmembers: $159.


Visit www.apta.org/thesource to register!!

Is anyone in the Tidewater district interested in a monthly (or every
other month) sports/ortho journal club?  I'd be willing to coordinate
and have space available in Virginia Beach for us to meet.  Please
email me at Kimberly.kranz@... if you are interested.

Kim Kranz, PT, DScPT, OCS, SCS, Cert.MDT

Below please find two links to information from TrailBlazer Health. The first outlines website enhancements and the second reviews appropriate addresses for redeterminations/reopenings.

http://www.trailblazerhealth.com/Tools/Notices.aspx?DomainID=1&ID=12722

http://www.trailblazerhealth.com/Tools/Notices.aspx?DomainID=1&ID=12722

On September 2, 2008 National Government Services (NGS) released a draft local coverage determination (LCD) for outpatient pulmonary rehabilitation. The LCD language and instructions for comment submission can be accessed via the link below.

 Comments are to be submitted directly to NGS no later than October 12, 2008.

 http://www.ngsmedicare.com/NGSMedicare/lcd/L28424_active_lcd.htm

If you have any questions, please contact AngelaSBrooks@....

Everyone - Below you will find a few announcements about upcoming educational opportunities from Trailblazerhealth. If you are not receiving this type of information from Trailblazerhealth and would like to sign up to do so, please go the Trailblazerhealth website at www.trailblazerhealth.com and sign up for the Traiblazer ListServ.

________________________________________________________

Top Billing Errors and Resolutions Web-Based Training
September 24, 2008
The Provider Outreach and Education (POE) department posts the top billing errors and resolutions quarterly to the TrailBlazer Web site. This event will provide detailed information regarding the top errors and information on how to prevent them.
http://www.trailblazerhealth.com/calendar/EventRegistration.aspx?id=538&DomainID=1

Applies to Part B Virginia providers

Managing Denials and Rejects Web-Based Training
September 16, 2008
This workshop will assist providers and their billing staffs with managing Medicare claim denials and rejections. Topics will include understanding the remittance notice, recognizing the difference between denied and rejected claims, the top 10 Virginia claim errors, denials due to Local Coverage Determinations and the National Correct Coding Initiative, and the appeals process. This session is recommended for providers and billing staff who want to learn to manage denials and rejections and understand coverage limitations, which will lead to cleaner claim submissions and faster reimbursement.
http://www.trailblazerhealth.com/calendar/EventRegistration.aspx?id=564&DomainID=1

On the Radar Web-Based Training
September 30, 2008
Would you like to know what issues are "on the radar" at TrailBlazer? This session will focus on data analysis of the Virginia CERT initiative. The workshop will provide an overview of errors identified based on CERT audits as well as specific information on consultations and new and established patient office and outpatient visit codes. This is a great opportunity for practices to learn from other providers' mistakes and take actions to make sure they are compliant with Medicare regulations. TrailBlazer's goal is to bring the audit results to the providers' attention, provide specific details of how to prevent problems in their practice and reduce the TrailBlazer CERT error rate in Virginia.
http://www.trailblazerhealth.com/calendar/EventRegistration.aspx?id=565&DomainID=1

The following  was supplied  by Trailblazer Health Enterprises, LLC.

_____________________________________________________

Information for Eligible Professionals Who Participated in the 2007 Physician Quality Reporting Initiative (PQRI) - CMS is pleased to announce 2007 PQRI Final Feedback Reports are available on a secure Web site. Two MLN Matters articles on accessing the reports are now available that can assist individual eligible professionals and group practices that reported valid 2007 PQRI quality measures data to Medicare. The reports are organized by Tax Identification Number (TIN). For eligible professionals reporting measures for 2007 PQRI under a group practice TIN, the group practice determines who can access the feedback report for the group practice or organization.

The first article, "Steps for Individual Eligible Professionals to Access Their 2007 PQRI Feedback Reports Personally," SE 0830, can be accessed at: http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0830.pdf.

The second article, "Steps for Organizations to Access Their 2007 PQRI Feedback Reports," SE 0831, is available at: http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0831.pdf.

Any questions about the feedback report should be directed to the Report Delivery System Help Desk referenced at the end of the MLN Matters articles. You should first register for access through the Individuals Authorized Access to CMS Computer Services (IACS) system to receive an IACS user ID and password, which you will use to access the PQRI feedback report. Additional educational resources and information about the PQRI program are available at: http://www.cms.hhs.gov/PQRI.

The following information was forwarded by the APTA on July 1. This is an extremely concerning outcome and bears repeating. IF you have not taken the time to reach out to the legislators,  please do so now by going to http://vocusgr.vocus.com/grspace2/WebPublish/Controller.aspx?SiteName=APTA&Definition=ContactLegislators&IssueID=3419.

_______________________________________________________________

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