Eli's Rehab Report

Published on Wed Sep 26, 2007 PDF

Alexandria, Va. -- Physical therapists performing wound-care services at outpatient hospitals could be affected by a new proposed rule from CMS, according to the July 27 edition of PT Bulletin Online.

The rule first attempts to clear up confusion over wound-care payments: In the proposed rule for 2008 hospital outpatient prospective payment (OPPS), CMS clarifies that physical therapists performing wound-care services under a certified plan of care in an outpatient setting must bill under the physician fee schedule -- not OPPS. However, nurses providing wound care using the same CPT codes would have their services placed into an ambulatory payment classification (APC) group and billed under the outpatient prospective payment system (OPPS), the Bulletin said.

But that's not all: CMS also proposes reducing payments for outpatient hospital departments in 2009 by 2 percent if they do not report on 10 quality measures listed in the rule. Meanwhile, the agency is considering 30 new quality measures for 2010, one of which is screening for falls risk -- a measure that PTs and OTs can report under the physician quality reporting initiative (PQRI) program, the Bulletin said.

For more information on how PTs and OTs can participate in PQRI, see "Practice Pointers: Clear up PQRI Confusion -- and Set Yourself up for Some Cash" and Physical Medicine & Rehab Coding Alert, Vol. 8, No. 9.

The proposed rule will appear in the Federal Register on Aug. 2. CMS will accept comments until Sept. 14, and proposed changes take effect Jan. 1, 2008.