AACVPR REIMBURSEMENT UPDATE
SEPTEMBER 11, 2007

The Pulmonary and Cardiac Rehabilitation Act of 2007

The most likely vehicle for S.329/HR 552 will be a Medicare bill that follows a bill exclusively addressing the State Children’s Health Insurance Program (SCHIP). A separate Medicare bill will be needed to resolve the 10% physician pay cut to take effect on January 1, 2008. Therefore, AACVPR has intensified its focus to ensure inclusion in a Senate Medicare bill and to also ensure that House conferees (Dingell, Rangel, Stark, and Pallone, among others) agree to the inclusion of our bill. AACVPR will implement additional dedicated strategies to make this happen.

Between now and the time when a Medicare bill begins to move later this fall, please continue your efforts to add Senate and particularly House co-sponsors in your state and district, respectively. A Congressional member can sign on as a co-sponsor any time, so now is the time to keep the pressure on. To see if your Representative is a co-sponsor click here and to see if your Senator is a co-sponsor click here or visit the AACVPR Grass Roots Web page. Please check to make sure your Representatives and Senators are on that list or do something about it! All the information you need to take action is posted on the web site or call your Affiliate Reimbursement Contact Person or Affiliate President. They’d greatly appreciate your participation.

It really is now or never (or at least not for a long, long time). A secure future for Medicare reimbursement of cardiac and pulmonary rehabilitation depends on the passage of the Pulmonary and Cardiac Rehabilitation Act of 2007. Every CR and PR professional must act NOW to make sure that we have as many co-signers as possible.

CMS Proposes G Codes for Cardiac Rehabilitation

The AACVPR Reimbursement Update of August 2, 2007 discussed the proposed rule change published in the Federal Register to replace the current cardiac rehabilitation CPT codes 93798 and 93797 with G codes effective January, 2008. The AACVPR, the American Hospital Association, and the American College of Cardiology will submit public comments to the Centers for Medicare & Medicaid Services (CMS) by the deadline of September 14, 2007, expressing specific concerns with the proposed changes. AACVPR’s comments will be posted on the Reimbursement section of the AACVPR web site for your viewing when submitted. Keep in mind, these are proposed changes by CMS. The final rule will be published in the Federal Register later this fall.

As always, AACVPR will provide members with the latest information as it becomes available.

CMS Announces New MAC Contract

On September 5, 2007, CMS awarded the Medicare Administrative Contract (MAC) for Jurisdiction 5 (which includes the states of Iowa, Kansas, Missouri, and Nebraska) to Wisconsin Physician Services Health Insurance Corporation (WPS). Over the next year, WPS will take over Medicare processing currently provided by Fiscal Intermediaries and Carriers in these states. The exception would be for hospitals that are part of a large hospital system. These hospitals will most likely be in the jurisdiction where corporate headquarters is located.

AACVPR will be working closely with the state Affiliates in each MAC jurisdiction through this transition. This is an opportunity to provide clinical expertise and foster a relationship with future Medicare contractors.

The announcement of remaining awards for 2007 MACs has been slightly postponed. The contract for MAC Jurisdiction 12 (Delaware, DC, Maryland, New Jersey, and Pennsylvania) has been delayed until late September. J-1 (California, Hawaii, and Nevada) and J-2 (Alaska, Idaho, Oregon, and Washington) are expected to be announced mid-October. The J-13 (Connecticut and New York) award is scheduled for mid-December. The remaining seven MAC contracts will be awarded in 2008. AACVPR will continue to provide members with the most current MAC information as it becomes available.

Karen Lui, R.N., M.S.
(FL phn) 239-768-6412
(DC phn) 703-752-4353
Karen@GRQConsulting.com