In The News

Surgery may not be the go-to many people believe it to be when treating a ruptured Achilles' tendon, according to findings from a new study conducted in Norway. Researchers there found that pain and function outcomes after one year were nearly the same regardless of whether the rupture was surgically repaired or addressed through a nonsurgical approach. Both open-repair and minimally invasive surgical techniques were analyzed in the study.

Read Study Review

 

Federal Independent Dispute Resolution (IDR) Portal Launched

April 15, 2022, the Centers for Medicare & Medicaid Services opened the Federal Independent Dispute Resolution (IDR) process for providers (including air ambulance providers), facilities, and health plans and issuers to resolve payment disputes for certain out-of-network charges.

To start a dispute, an initiating party will need:

  • Information to identify the qualified IDR items or services;  
  • Dates and location of items or services;
  • Type of items or services such as emergency services and post-stabilization services; 
  • Codes for corresponding service and place-of-service;  
  • Attestation that items or services are within the scope of the Federal IDR process; and
  • The initiating party’s preferred certified IDR entity. A list of certified entities can be found here

At the end of the 30-business-day open negotiation period, initiating parties have 4 business days to initiate a dispute via the portal. As a result of the recent decision in Texas Medical Ass’n, et al. v HHS, the Departments will give disputing parties whose open negotiation period expired before today, April 15, 2022, 15 business days to file an initiation notice via the IDR Portal.

Even after starting the Federal IDR process, disputing parties can continue to negotiate until the IDR entity makes a determination. If the parties reach an agreement on the out-of-network payment rate, they should email the certified IDR entity and the Departments (at [email protected]).

If the disputing parties experience extenuating circumstances during the IDR process that prohibit them from complying with deadlines to submit information, they may email the Departments (at [email protected]) to receive a Request for Extension Due to Extenuating Circumstances form and instructions for next steps.

To learn more about the independent dispute resolution process, including to read guidance materials, FAQs, and model notices, visit www.cms.gov/nosurprises

 

APTA Colorado's Latest Blogs 

At APTA Colorado, our goal is to advance the practice of physical therapy in our state through advocacy, education, and connection. To keep you updated on the latest efforts across these areas of focus, we are excited to announce the launch of our new members only blog. Explore our first posts below or visit the APTA Colorado website to read all available posts. The blog will be updated regularly, so be sure to check back soon for new posts! 

Latest Blogs:

  • April 19 - Featured Member Profile: Michael Harris-Love, PT, MPT, DSc, FGSA
  • April 5 - House of Delegates Sets Changes into Motion for 2022 and Beyond

Members, click here to login & read the blogs! 

 

PTAs: Advanced Proficiency Pathways Enrollment Deadline May 31

Prioritize your career development and enrich your knowledge in a specific area of care through APTA’s innovative program.

Ready to deepen your PTA knowledge and skills, and be nationally recognized for your career development? APTA's PTA Advanced Proficiency Pathways program can help you do just that.

APTA’s Advanced Proficiency Pathways program is open through May 31 for the next quarterly enrollment period. It's a unique opportunity for PTAs from across the country to grow their understanding in a specific area of care through a combination of in-person or online coursework, mentored clinical experiences, and clinical work hours.

Click here to learn more. 

 

Proposed FY 2023 SNF Rule: CMS Makes Good on Threat to Enact Cuts

CMS says it's because the PDPM payment system isn't working out as planned. Some of the pain will be softened by cost-index adjustments.

Public comment deadline: June 10

The big picture: The Patient-Driven Payment Model adopted for skilled nursing facilities in the fall of 2019 was supposed to cost about as much as the previous Resource Utilization Groups system, but so far, that hasn't been the case. CMS believes the only way to make things right is through a 4.6% reduction in PDPM payment, something it signaled it was considering in last year's SNF rule. However, the impact of the cuts could be somewhat offset by a proposed 3.9% "market basket" increase, meaning that SNFs would be facing something closer to a 0.7% decrease overall, according to the proposed rule.  FY 2023 begins Oct. 1, 2022, for the SNF Prospective Payment System.

APTA is reviewing the proposed rule to submit comments by the June 10 deadline, as well as to prepare for the proposed home health rule now in the works at CMS. Typically, the home health rule contains provisions that echo SNF rules.

Click here to read more. 

 
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