The IRG Report


24

Sep 2016

South Carolina Supreme Court Overturns Ban on Integration of Physician and PT Services

The South Carolina Supreme Court has overturned a previous ruling which prohibited physicians from employing physical therapists in the Palmetto State.  Issued on September 14th, the Court’s decision in Joseph et al v South Carolina Department of Licensing, Labor, and Regulation, South Carolina Board of Physical Therapy concludes the decade-long fight over physician employment of PTs by overruling the Court’s 2006...

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30

Jun 2016

CMS Partners with StrategicHealthSolutions to Perform Targeted Manual Medical Reviews

The Centers for Medicare & Medicaid Services (CMS) has contracted with StrategicHealthSolutions, a Supplemental Medical Review/Specialty Contractor (SMRC) to assist with lowering improper payment rates and increasing efficiencies of the medical review functions of the Medicare and Medicaid programs, including the manual medical review process for therapy expenditures above the $3,700 therapy thresholds.  As you may recall, the Medicare Access...

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31

May 2016

Assessing Your Physical Therapy Practice: Do You Know What You Don’t Know?

We continually have the opportunity to meet and interact with physician practice administrators and physical therapy clinic directors from all over the country.  A common phrase we often hear when the conversation turns to their therapy clinic’s performance is, “We THINK we’re doing OK, but we don’t really know what we don’t know”.  Today, we’ll review some of the key...

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31

May 2016

Clinical Outcomes Part 3: Patient-Reported Outcome Measures (PROMs) in Therapy

It is becoming increasingly rare to pick up a journal or participate in an alternative payment model webinar that doesn’t mention Patient-Reported Outcome Measures (PROMs) as a key element in the transition toward outcome-based reimbursement.  While the PROM acronym may be relatively new to therapy providers, the practice of using patient-reported measures to help quantify patient progression has been on...

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05

Apr 2016

Clinical Outcomes Part 2: Deciding What to Measure

This post is the second in a series aimed at the capture, reporting, and relevance of clinical outcomes in the outpatient physical therapy environment.  In the previous blog post, I talked a little about the role that outcomes will play in a value-based reimbursement environment as well as the importance of outcomes in managing your clinic and in helping to...

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21

Mar 2016

Clinical Outcomes: Fad or Trend?

This post is the first in a series aimed at capturing, reporting, and the relevance of clinical outcomes in the outpatient physical therapy environment.  As healthcare continues to move toward alternative payment models and value-based reimbursement, providers are hearing more and more about the importance of capturing clinical outcome data and assessing the quality of the care provided.  From a...

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21

Mar 2016

CMS Updates the Manual Medical Review Process (Again)

On February 9th, 2016, CMS announced changes to the Manual Medical Review process for therapy claims above the $3,700 threshold.  As you will recall, the Manual Medical Review process has gone through several changes since its inception in 2012 as a provision of the Middle Class Tax Relief and Job Creation Act.  At various stages, it has included a pre-authorization...

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15

Dec 2015

Medicare and PQRS Updates for 2016

As 2015 comes to a close, it isn’t too soon to start looking ahead to next year.  From a Medicare standpoint, there aren’t many changes in store for 2016 which may be good news or bad news depending on whether you are a glass half-empty or a glass half-full kind of person.  While therapists would certainly welcome any changes that...

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04

Dec 2015

PQRS Informal Reviews, Feedback Reports, and Performance vs. Reporting Rates

As the PQRS informal review request deadline has now been extended through December 16th, many providers who received notification letters indicating they would be subject to the negative payment adjustment in 2016 have been trying to access their annual feedback reports to determine exactly how and why they missed the successful reporting threshold.   To recap, an informal review may be...

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19

Nov 2015

Deadline is Rapidly Approaching for Therapy Providers To Request Informal Review of PQRS Payment Adjustment

NOTE: The post below has been updated to reflect CMS’s extension of the informal review request deadline through December 11th, 2015 which was announced the day after the original blog entry was posted. CMS has sent letters to providers who are subject to the negative PQRS payment adjustment in 2016. Eligible professionals who believe they have been incorrectly assessed the 2016...

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