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

2. LEGISLATIVE AND REIMBURSEMENT UPDATE
NO DISCLOSURES

3. 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

4. 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

5. 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

6. Legislative and reimbursement update
Referring Physician
Supervising Physician
Medical Director

7. 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.

8. 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 Section 603 of the Balanced Budget Act of 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

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

10. 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

11. Legislative and reimbursement update
Use code 93668
Diagnosis code: I70… (listed in Medicare Matters)
Reject claims with 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

12. Legislative and reimbursement update
ANY QUESTIONS ?