Legislative and reimbursement update April 17, 2018 Debra B. Lund, MS, Rcep, faacvpr Maryland reimbursement contact person

LEGISLATIVE AND REIMBURSEMENT UPDATE NO DISCLOSURES

Legislative and reimbursement update AACVPR website, review basics of billing for CR and PR Updates in requirements for Cardiac Rehabilitation Programs and Pulmonary Rehabilitation Programs DOTH Updates Supervised Exercise Therapy (SET) for PAD patients

LEGISLATIVE AND REIMBURSEMENT UPDATE AACVPR WEBSITE: Reimbursement Updates, MAC updates, contact people MAC is JL Billing basics-Cardiac Rehabilitation 93798 93797 Diagnosis codes-MI (within 1 year), PTCA, Valve replacement/repair, CABG, angina, transplant

Legislative and reimbursement update Billing Basics- continued Must have an exercise component At least 30 minutes to 90 minutes for 1 session Billing Basics-Pulmonary Rehabilitation G0424 COPD moderate to very severe G0237, G0238, G0239 respiratory services- other diagnoses

Legislative and reimbursement update Referring Physician Supervising Physician Medical Director

Legislative and reimbursement update Update in requirements-both Cardiac and Pulmonary Rehabilitation Programs Referral must be from MD or DO Program must to supervised by a MD or DO Physician prescribed exercise as part of ITP must be established, reviewed and signed by a MD or DO CMS Auditor-Payment was denied when ITP was not signed by a physician prior to or on the first day that Cardiac Rehabilitation and Pulmonary Rehabilitation was billed.

Legislative and reimbursement update DOTH Updates HR1155/S1361 Supervision requirements. Allowing a NP, PA to supervise Cardiac Rehabilitation Programs and Pulmonary Rehabilitation Programs. INCLUDED IN ACCESS ACT- EFFECTIVE DATE 1/1/2024 DOTH 2018- Section 603 of the Balanced Budget Act of 2015. Any hospital outpatient services that were moved to or established off campus location after 11/2/15 would be reimbursed according to physician fee schedule

Legislative and reimbursement update Supervised Exercise Therapy- (SET) for Symptomatic Peripheral Artery Disease (PAD): Medicare Matters:10295 revised SET Program must include: Sessions lasting 30-60 minutes Comprising a therapeutic exercise training program Conducted in hospital outpatient setting or a physician office Delivered by qualified auxiliary personnel

Legislative and reimbursement update Be under direct supervision of a physician, PA, NP who must be trained in BLS and ACLS Patients must have a face to face visit with physician responsible for PAD treatment to obtain referral for SET MAC has discretion to cover SET beyond 36 sessions over 12 weeks and may cover additional 36 sessions over extended period of time-use KX modifier SET is non covered for people with absolute contraindication to exercise as determined by primary attending physician

Legislative and reimbursement update Use code 93668 Diagnosis code: I70… (listed in Medicare Matters) Reject claims with 93668 which exceed 36 sessions within 84 days from date of 1st service when KX modifier in not included Medicare’s Common Working File will display remaining SET sessions

Legislative and reimbursement update ANY QUESTIONS ?