Current News

Are your patients aware of what is at risk if HR 552/S.329 is not passed? Have you asked them to write or call their congressional member in the U.S. House of Representatives? Has that U.S. Representative heard from those who we are doing this for--our patients? Have your state s two U.S. senators heard from everyone who receives and provides these services?

In less than two weeks, over 80 members of AACVPR and its Affiliate societies will travel to Washington, D.C. to represent you and your patients in asking for support of this bill. If enough constituents (voters!) have asked for co-sponsorship, the issue is much more likely to have the proper attention by the legislator and result in support. If only one or a few professionals have made this request, it will be lost in the plethora of issues that congressional members are asked to consider every day.

How important is this to you? If you and your patients have not taken action recently, please do so immediately by going to the AACVPR Web page. This is so simple; it takes less than five minutes to do!

Time is of the essence in assuring that this provision is included in the next Medicare bill being discussed in Congress right now. Having a majority of co-sponsorship is our best assurance of success. We have the powerful voice of our patients--please help them take action, send a letter or make a call, or call your affiliate leadership and ask what you can do to help.

March 10, 2008
Spring 2008 Brochure
JANUARY 24, 2008

New CMS Release, Effectively Immediately

AACVPR has learned that CMS has released a transmittal implementing changes in Cardiac Rehabilitation services paid under the Hospital Outpatient Prospective Payment System. As a valued member of AACVPR, we are keeping you informed with the most updated information available.

The Centers for Medicare and Medicaid Services (CMS) has provided its contractors with guidance for implementation of policy changes related to provision of and billing for cardiac rehabilitation services, effective immediately. These changes are related to the hospital outpatient prospective payment final rule, published in the November 27, 2007 Federal Register. The new communication from CMS, Transmittal 1417, dated January 18, 2008, addresses a wide range of policy changes, with one section devoted to the provision of cardiac rehabilitation services.

Background

The November 27th final regulation made two important changes in the provision of cardiac rehabilitation. First, CMS shifted from the concept of "sessions" to the more definitive use of "hours" as a measurement unit, defining one unit of HCPCS 93797 or 93798 as at least one hour (and up to 1 hour, 59 minutes). Secondly, CMS opened the door to permit programs to bill more than one session/hour per day per beneficiary. The new transmittal provides important guidance on those two key issues.

The New Cardiac Rehabilitation Provision

The following language is taken directly from the new Cardiac Rehabilitation Provision within Transmittal 1417: "The National Coverage Determination for cardiac rehabilitation programs requires that programs must be comprehensive and to be comprehensive they must include a medical evaluation, a program to modify cardiac risk factors (e.g., nutritional counseling), prescribed exercise, education, and counseling. (See the National Coverage Determinations (NCD) Manual, Pub. 100-03, section 20.10.) A cardiac rehabilitation session may include more than one aspect of the comprehensive program. For CY 2008, hospitals will continue to use CPT code 93797 (Physician services for outpatient cardiac rehabilitation, without continuous ECG monitoring (per session)) and CPT code 93798 (Physician services for outpatient cardiac rehabilitation, with continuous ECG monitoring (per session)) to report cardiac rehabilitation services. However, effective with dates of service January 1, 2008 or later, hospitals may report more than one unit of HCPCS codes 93797 or 93798 for a date of serv! ice if more than one cardiac rehabilitation session lasting at least 1 hour each is provided on the same day. In order to report more than one session for a given date of service, each session must last a minimum of 60 minutes. For example, if the services provided on a given day total 1 hour and 50 minutes, then only one session should be billed to report the cardiac rehabilitation services provided on that day."

While the language can be confusing, cardiac rehabilitation programs are faced with several options in terms of implementation of this transmittal.

* Programs should know that some Medicare contractors do not recognize use of code 93797, unmonitored cardiac rehabilitation. CMS has clarified that it is within the authority of each contractor to make that decision. Some programs may determine that their current treatment protocols and business model do not need to be changed, as long as the 60 minute minimum for each session is met. After all, there is nothing in this new rule that mandates change beyond the requirement that each billable "session" be at least 60 minutes in duration.

If your entry and exit ECG strip does not document time, you might consider adding documentation of session duration. This could be as simple as noting the start and finish time of each exercise session.

Example 1: A patient is able to complete only 45 minutes of ECG-monitored exercise in the first visit. This would be non-reimbursable because the patient did not achieve the minimum 60 minute requirement.

Example 2: A patient spends 60 minutes doing ECG-monitored exercise and 30 minutes in a stress management class. This would be reported as one hour of HCPCS 93798 because it does not meet the requirement of the minimum of 120 minutes required for submission of two hours of cardiac rehabilitation services.

Example 3: A patient spends 70 minutes performing ECG-monitored exercise and 50 minutes in a class on risk factor modification. This would be reported as one 93798 hour for that day.

Example 4: A patient spends 60 minutes performing ECG-monitored exercise and 60 minutes in a stress management class. This would be reported as one 93798 and one 93797 service of cardiac rehabilitation. (Keep in mind that many Medicare contractors will not reimburse for the 93797 code.)

* Programs that do decide to shift into a model that will provide more than one billable session (at least 120 minutes) must remember that the total number of sessions is still set at a threshold of 36, as clearly outlined in CMS coverage policy 20.10. That is, 36 sessions of 93798 equals the 36 session threshold, as does 30 sessions of 93798 + 6 sessions of 93797. Program directors should also recognize that multiple sessions per day would likely have the aggregate effect of an actual reduction in exercise therapy time, as a second session would likely focus on components of cardiac rehabilitation other than monitored exercise training.

Example 1: Your program provides three ECG-monitored hours (93798) per week and one hour of dietary education per week (93797). However, once a total of 36 sessions has been reported for a combination of services using the 93797 and 93798 definitions, that patient's course of cardiac rehabilitation is complete and no further reimbursement will be provided by Medicare, even though the patient did not receive 36 exercise hours (93798). That patient's course would translate to 4 hours per week over 9 weeks to equal the 36-session limit, as one example.

Example 2: The exercise session lasts anywhere between one and two hours (60-119 minutes), so it is still considered one session. An exercise session would need to be between two and three hours (120 minutes or greater) to be reportable as two units of HCPCS code 93798.

As stated in the CMS Cardiac Rehabilitation NCD 20:10, Medicare contractors have the discretion to cover cardiac rehabilitation services beyond 18 weeks or 36 sessions on a case-by-case basis, not to exceed a total of 72 sessions for 36 weeks. However, the granting of an extension for the cardiac rehab benefit by a contractor is rare.

* As always, programs must ensure that all billable services to Medicare are in accordance with accepted coding practices. The definition of codes 93797 and 93798 are fairly specific

o 93797 -- Physician services for outpatient cardiac rehabilitation; without continuous ECG monitoring (per session);
o 93798 -- with continuous ECG monitoring (per session)

Therefore, it is imperative that any services billed under these codes be documented in the medical record be reflective of the actual services provided to the beneficiary.

This important information is sent to you as a valued member of AACVPR. As always, AACVPR will keep members updated with the most current information for billing and reimbursement of cardiac and pulmonary rehabilitation.

AACVPR REIMBURSEMENT UPDATE JANUARY 18, 2008

S. 329 and HR 552
PERSISTENCE, PERSISTENCE, PERSISTENCE

This has become the mantra of the AACVPR Board of Directors, the Health Policy & Reimbursement Committee, and I hope it is yours as well. As was reported in the December 20, 2007 AACVPR Reimbursement Update, our bill language was not included in the shaved-down version of a Medicare bill that passed in December. That bill addressed only short-term provisions for a looming physician pay cut and a few other time-sensitive Medicare issues.

The good news is that AACVPR s bill language may be included in that physician fee-fix Medicare bill which is being discussed right now on the Hill for passage possibly as early as this spring. To make this happen one critical political lever is the need for a true majority of both the House and the Senate to sign on as co-sponsors for both HR 552 and S. 329. In the House of Representatives, we have 146 co-sponsors which means we currently lack the support of 289 members. If only an additional 72 of those members agree to co-sponsor HR 552, the majority of House members (218) will be co-sponsors. That would greatly increase the chance of getting HR 552 included in the larger Medicare vehicle. It is particularly important to increase the number of House co-sponsors in the next few months as that bill is taking shape. On the Senate side, currently there are 62 senators who have not lent their support to S.329. ! Only 13 more co-sponsors would achieve the 51 needed for a majority in the Senate.

AACVPR has recently launched a new Web page to make the process of sending this important message to any of your DC Legislators as simple as a couple of mouse clicks. It is designed to be user friendly for all, including patients, physicians, administrators and other interested groups. You don t need to be a member of AACVPR to send a message to your Representative and Senators. The new AACVPR click and send tool makes it quick and easy for you to identify YOUR representative and to email a letter or make a phone call to your elected officials. This feature will give you editable text. Please make sure to edit the text to fit your needs and inform those you ask to send an email to do the same. The AACVPR Web page! has also posted the number of Representatives and Senators in your state that are needed and the current Representative and Senate co-sponsors of our bills.

We are too close to miss the opportunity for successful passage of The Pulmonary and Cardiac Rehabilitation Act of 2008. To ensure the future viability of Cardiac and Pulmonary Rehab Programs, be part of the reason HR 552 and S. 329 is signed into law. If our bill is to pass this year, each member and program needs to take action NOW.

ANNOUNCING - AACVPR DAY on the HILL 2008

Plan now to attend the AACVPR Day on the Hill. This yearly AACVPR event has made a significant difference in garnering support for S.329 and HR 552. Nothing is more effective than a face-to-face meeting with your Representative, Senators and DC congressional office health staff personnel, especially in an election year.

If you are new to this process, AACVPR will provide you with the education and tools for a successful Hill experience. You will receive background information, talking points, a preparatory teleconference the preceding week, as well as an experienced colleague to accompany you to your Hill appointments, if requested.

Please register with AACVPR to attend this event. There is no cost for you to participate, other than transportation to and lodging in Washington, DC. Please consider educating your hospital administrators on the importance of this issue to seek funding for your participation. A number of Day on the Hill participants have successfully done so in the past.

SCHEDULE:
THURSDAY, FEBRUARY 28:

Noon Hotel Lobby:
Appointment partnering arrangements made
Capitol Hill Appointments
6:00 PMOrientation Program

FRIDAY, FEBRUARY 29:
All day Capitol Hill Appointments

HOTEL:

Holiday Inn Capitol
550 C. St. SW (within walking distance of Capitol Hill)
Washington, DC 20024
1-202-479-4000 (Ask for In-house reservations in conjunction with AACVPR event )
Special Room Rate for night of 2-28-08: $209.00

The hotel cut-off date for this discounted rate is 1-28-08 and space is limited-please book early. Call Karen Lui at (239)768-6412 if room sharing is desired.

If you are planning to attend, now is the time to begin making appointments with your legislators. See the DOTH information on the AACVPR Web site for information on how to make an appointment.

75/25 RULE FIX PASSES

The Medicare bill that did pass in the final days of December, 2007 provided good news for the small segment of cardiac and pulmonary rehab practitioners who work in inpatient rehabilitation facilities (IRFs). Included in the bill was a permanent fix to the 75% rule that limits the percentage of cardiac and pulmonary rehabilitation admissions in relation to other diagnoses treated in IRFs. The bill caps the rule at 60%, which, while still restrictive, will allow these facilities to continue to serve a significant segment of the elderly and physically disabled cardiopulmonary population.

MEDICARE ADMINISTRATIVE CONTRACTOR (MAC) AWARDS DELAYED

The Centers for Medicare and Medicaid Services (CMS) was due to announce which contractors were selected for MAC jurisdictions 2, 7, and 13 by the end of 2007. That process was put on hold until sometime in 2008 according to CMS sources. The awards to MAC jurisdictions 1 and 12 (to Palmetto and Highmark, respectively) are currently being contested by other bidders for those Medicare contracts. The transition to a MAC continues for jurisdictions 4 and 5. MAC jurisdictions and specific information on each are on the AACVPR MAC Web page. As soon as AACVPR hears more about the resumption of the MAC transition, you will be informed.

As always, the leadership of AACVPR is working hard to provide members with the best and most current information available.

DECEMBER 20, 2007

AACVPR REIMBURSEMENT UPDATE

Bare Bones Medicare Bill Passes To Be Continued in 2008!

As AACVPR members are aware, the Pulmonary and Cardiac Rehabilitation Act of 2007 is the top priority for AACVPR and the leadership has focused concentrated efforts to ensure that the bill would be a part of a larger Medicare bill in 2007. Tuesday, December 18th we learned that a smaller bill focused on immediate fixes to healthcare payments was sent to the Senate floor for a vote. In the bill language, a Medicare pay cut for physicians has been temporarily delayed and states will continue to fund children's health care, but most of the other Medicare issues, including S.329/HR 552, will have to wait to be addressed in early 2008. The measure passed in the Senate and is expected to pass in the House as well. It allows physicians a 0.5% pay increase rather than a 10% pay cut and extends several Medicare programs until June 30.

While this is disappointing news, it should be seen only as a delay, not as a defeat. There is every indication that our provision continues to have strong bi-partisan support and will be part of a larger Medicare package that Senate Finance Chairman Baucus is very committed to crafting when Congress resumes in January.

It will be important for AACVPR members to keep the momentum going with active advocacy and AACVPR s new web-based tool will make that a much easier task for you. For a first hand look at the tool, click HERE. AACVPR Day on the Hill 2008 is tentatively scheduled for late February 2008 in Washington, D.C. and will be a crucial part of strengthening the visibility and importance of The Pulmonary and Cardiac Rehabilitation Act to our legislators in Congress. Please consider participating in this exciting AACVPR-sponsored activity. Watch for additional information on the AACVPR 2008 Day on the Hill, coming soon. As always, AACVPR will continue to support the profession and will keep each of you informed with the latest news and information as it relates to your cardiac and pulmonary rehab program.