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Reimbursement Rehab

Reimbursement Rehab. Susan Bauman, BSN, BC ISCVPR Cardiac Reimbursement Chairperson. S 382. Bill Text 113th Congress (2013-2014) S.382.IS

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Reimbursement Rehab

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  1. Reimbursement Rehab Susan Bauman, BSN, BC ISCVPR Cardiac Reimbursement Chairperson

  2. S 382 • Bill Text 113th Congress (2013-2014) S.382.IS “To amend title XVIII of the Social Security Act to allow physician assistants, nurse practitioners, and clinical nurse specialists to supervise cardiac, intensive cardiac, and pulmonary rehabilitation programs.” • Introduced by Senators Schumer, NY and Crapo, ID, on February 26, 2013 • Currently in Finance Committee/ Congressional Budget Office (CBO) • Should have no dollars attached for CBO scoring • Access to the Bill information - www.thomas.gov --- enter Bill number

  3. It’s Time to ACT • Contact BOTH Senators • Phone: ask for person responsible for healthcare issues • Email: (sample letter template in handouts) • In person: attend a local event with the Senators • Follow up for their decision in about 5-7 days • www.aacvpr.org has made available to all CR & PR professionals: • Senate Bill • Sample letter to our Senators (need to update) • Leave-behind document • Senate letter to Dr. Berwick (CMS) and CMS response • Communication tips

  4. Who to contact… • Dan Coats 493 RUSSELL SENATE OFFICE BUILDING WASHINGTON DC 20510 (202) 224-5623 Contact: www.coats.senate.gov/contact/ • Joe Donnelly B33 RUSSELL SENATE OFFICE BUILDING WASHINGTON DC 20510 (202) 224-4814 Contact: www.donnelly.senate.gov/contact.cfm

  5. KX Modifier • An attachment to the CR/PR codes for Medicare clients only • Identify necessity: • does the patient know? • access the patients Medicare Common Working File (CWF) • Ask your billing, coding departments to assist you • REQUIRED for ALL SESSIONS ABOVE #36 (as a Medicare beneficiary) • CMS began tracking 1/1/2010 • Example: • Jim had a CABG 5/2011, attended CR for 25 sessions. He then had an MI w/PCI 1/2013 and plans 19 sessions. Jim would need the KX modifier at session #12 of his current rehab program. • Carol had an MI 8/2006, attended CR for 19 sessions. She now is coming to CR after another PCI and plans 19 sessions. Carol doesn’t need the KX modifier.

  6. Resources • www.iscvpr.org • www.aacvpr.org • www.wpsmedicare.com • susan.bauman@porterhealth.com

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