How will Medicare Regulations Affect Your Practice?

Stephanie Yamkovenko

Want to know how Medicare Part A regulations will affect you? Fortunately AOTA’s Federal Regulatory Affairs team has you covered. They recently analyzed several proposed rules for Medicare Part A settings and submitted comments to the Centers for Medicare & Medicaid Services (CMS) on issues that can affect occupational therapy.

If you work in an inpatient rehab facility:

The proposed rule has some restrictions on group therapy. We urged CMS to explore this issue in greater depth and conduct research on the outcomes of individual vs. group therapy before adopting policy changes. We said that limiting group therapy without data would be premature.

The proposal also includes a definition of group therapy. Because CMS didn’t propose a definition for concurrent therapy, AOTA suggested that both group and concurrent should be defined. AOTA commented that the definition for group therapy and concurrent therapy should be consistent across settings (such as with the definitions for skilled nursing facilities).

CMS is also proposing a data collection process on the amount and mode of therapies (individual, group, and co-treatment). CMS estimates that the data collection would take 4 minutes to complete, but we commented that it would more likely be 15 to 20 minutes to accurately capture the therapy data.

If you work in a hospital:

You’re probably familiar with the observation status. Although CMS did not propose any changes to its recent “two-midnight rule” in the proposed rule, AOTA provided comments about how the rule affects OT practitioners, clients, and billing practices.

We argue that the differences between inpatient and outpatient billing can create ethical challenges for therapists if they are asked by hospitals to go back and retroactively supplement the record with the patient information necessary to meet the outpatient requirements (like G codes).

We also commented that prolonged stays in observation status can create confusion for Medicare beneficiaries.

If you work in a skilled nursing facility:

CMS heard that some providers had concerns about the limitations on the use of the COT OMRA, such as when reclassifying a resident into a therapy resource utilization group (RUG).

CMS made an effort to respond to these concerns, and we asked for more clarity about the way the End of Therapy OMRA works after 3 missed days when therapy is still ongoing.

Read AOTA's comment letters

AOTA members can read the full comment letters and get links to the proposed rules. AOTA expects that the final rules will be released in August. Those rules would go into effect October 1, 2014.