The purpose of the Kentucky Cardiopulmonary Rehabilitation Association (KCRA) is to provide education and networking opportunities to professionals working in cardiac and pulmonary rehabilitation. We serve as a state affiliate organization of the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR).
Welcome to the KCRA website. If we can be of service to you, please check the Executive page for our contact information and give us a call.
Health Policy & Reimbursement Update
CMS Coverage Policy on Supervised Exercise Therapy for Peripheral Artery Disease (PAD) – April 10, 2018
On April 3, 2018, CMS (Centers for Medicare & Medicaid Services) changed the National Coverage Determination (NCD) 20.35 for Supervised Exercise Therapy (SET) for Peripheral Artery Disease (PAD) to exclude the hospital outpatient setting as an allowed setting. This was immediately questioned by AACVPR and partner societies, ACC and AHA, who had initially requested coverage of SET for PAD patients and worked with multiple professional societies toward the final Medicare coverage policy for SET that was effective May 25, 2017.
CMS clarified today the hospital outpatient settings were erroneously excluded from the revised MLN article and revised claims processing instructions. CMS is currently working on the quickest resolution to add hospital outpatient settings as an acceptable place of service and expects to have that correction completed long before the July implementation date CMS apologizes for any confusion this error caused.
MACs (Medicare Administrative Contractors) had been informed by CMS of the change in policy and this week the (erroneous) regulation change was was communicated by some MACs to hospitals in those regions. Your hospital should continue planning and providing SET PAD. AACVPR will post the corrected regulations (NCD, Claims Processing manual, MLN Matters) when they are available.
Please direct any questions to firstname.lastname@example.org.
Attention All MAC J-15 AACVPR Members,
In January of 2016, both Cigna Medical Directors (Dr. Berman & Dr. Sandler) responded to clarification over Non-Physician Practitioners (NPPs) referring to cardiac and pulmonary rehabilitation services. They stated that Cigna has NO guidelines restricting NPPs from being the referring provider for Cardiac or Pulmonary Rehabilitation services.
Most recently, CMS has reversed and clarified that MACs do not have the authority to determine whether non-physician practitioners (NP, PA, and CNS) may independently order CR/PR services. CMS interprets that it is bound by statutory language that categorizes CR and PR as “physician services”. This requires that an MD or DO must order Cardiac Rehabilitation services. Starting immediately, this means while NPPs may send a referral order to rehab to expedite the enrollment process, a physician would need to co-sign any referral order for these services.
If you have additional questions please contact me.
Richard Sukeena, MS, MBA, FAACVPR
AACVPR MAC Task Force J-15 Liaison