Regulations

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…

May 11, 2018: CMS corrected regulations for SET. SET for PAD may be provided in a hospital outpatient setting or a physician office setting, as was the intention of CMS before a technical error occurred in April MM10295 – Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM10295.pdf 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 &…

Skip to “Understanding intensive cardiac rehab.” Attention Cardiac Rehab Programs! Please be aware that Cigna (CSG MAC J15) released the below update regarding an upcoming Cardiac Rehabilitation ADR.  Please review the below information/documentation related to phase II Cardiac Rehabilitation charts and use this as a checklist to review your charts.  Per my discussion with Billing Compliance Analyst, CSG will focus on new/most recent claims (patients currently enrolled or just graduated) from phase II.  I also added a link to the…