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ADVANCE Perspective: Respiratory Views

Time to Evaluate Revised Pulmonary Rehab Rule Impact

Published March 10, 2010 1:06 PM by Vern Enge
 We're almost through the first quarter of 2010, and it's time to evaluate the impact of reimbursement and regulation changes in pulmonary rehabilitation programs.

Starting Jan. 1, the Center for Medicare and Medicaid Services (CMS) granted 12 weeks of pulmonary rehab for Medicare and Medicaid patients with moderate, severe, and very severe COPD.

Prior to the change, pulmonary rehab coverage had been provided on a piecemeal basis with some parts of the nation covering COPD and others not. For the first time, pulmonary rehab is covered nationally because of the new regulations.

How this will impact patient health remains an unknown, although the changes are expected to be significantly better. Those full-quarter sessions cover three one-hour sessions of rehab per week for 12 weeks.

Changes were a long-sought goal for numerous organizations including the American Association of Cardiovascular and Pulmonary Rehabilitation, the American Association for Respiratory Care, the American College of Chest Physicians, the American Thoracic Society, and NAMDRC.

Certain criteria must be met in providing the care. Pulmonary rehab must be furnished in a physician's office or a hospital outpatient setting where a physician is immediately available for consultations and emergencies at all times the services are furnished.

Programs must include five components documented in the medical record:

  • Physician-prescribed exercise, including some aerobic exercise, must be included in each session,
  • Education and training, including information on respiratory management and smoking cessation, should be provided,
  • A psychosocial assessment must be conducted,
  • An outcomes assessment must be in place, and
  • There should be a detailed plan showing how components are used for each patient.

While 36 rehab sessions are provided under the new law, an additional 36 sessions can be approved based on continued patient needs and a physician referral.

With a reimbursement rate of $50 per one-hour session, the new rules can mean the difference between rehab programs staying afloat or closing. In fact, the new rules may encourage facilities to add pulmonary rehab to their offerings if they are not already in place.

That critical first quarter is almost over, and it's time for rehab therapists to chime in with their experiences so far in 2010.

 

6 comments

Hi,

Has anyone been able to actuall be reimbursed at the $50.00 rate?  So far, all we a re able to obtain is about $23.00 per session.  

Angela Binns-Lindsey, Pulm Rehab - Manager, Mt. Sinai July 13, 2010 11:56 AM
New York NY

More new patients than we've had in a long time inspite of CMS exclusions.  Still taking care of all disease states, not just COPD.  I'm looking for input on how other programs are addressing the "face to face" meetings with the MD's pre and post program.  would appreciate any feedback.

Christopher Shope RRT, Sleep,CR/PR,PFT - Manager, Seton Health May 4, 2010 1:48 PM
Troy NY

Have a Cardiac proposing Pulm. rehab looking for the best sourse of information to start -policies, billing codes ect.

Jack Vespia, Cardiopulmonary - Director, Chatham Hospital March 20, 2010 6:31 AM
Siler NC

I also have had little change other than documentation and revising/adding forms. Patient care remains the same, and we continue with three one-hour sessions per week. I agree with a previous comment made regarding all other patients with a  diagnosis other than COPD being left out of the new CMS guidelines. I personally am seeing more & more restrictive patients who are in need of PR just as equally as the COPD population, which i will not abandon either, and continue to bill them as i have in the past also. Hopefully the new guidelines will eventually encompass all forms of lung disease in the near future!

Kami Norris, , RRT, PR Coordinator Proctor Hospital March 18, 2010 9:18 AM
Peoria IL

The upside is that we now have a common billing code and we are nationally recognized as the providers of a very important service to our clients. The downside is that so many of our former pulmonary rehab participants are excluded from the program because they don't have COPD. We have creatively developed an alternative program for these folks, and luckily we are able to continue to bill them as we had in the past. Patients with IPF, pre and post lung surgery, pre and post lung transplant, Cystic Fibrosis...the list goes on, also benefit from the same exercise and education that RTs provide to their pulmonary rehab. patients. Unfortunately, the majority of new patients being referred to our PR program do not qualify as per the new CMS guidelines, and we have to segway them into the alternative program, we will not abandon them. Perhaps one year the guidelines will be broadened as we continue to document the benefits all of our patients receive.

Meryl, Pulmonary Lab - BS,RRT,Coordinator , Phelps Memorial Hospital Center March 17, 2010 4:40 PM
Sleepy Hollow NY

LITTLE HAS CHANGED IN MY PROGRAM ECCEPT OUR DOCUMENTATION. I HAVE REVISED SEVERAL FORMS BUT STILL THE SAME PATIENT CARE. WE DID GO TO A FULL 2 HOURS INSTEAD OF 90 MIN AS BEFORE. I DON'T THINK WE HAVE BEEN DENIED ANY CLAIMS. GOOD LUCK TO THE REST OF YOU.

chris, gates,, PULMONARY - CRT, MMC March 16, 2010 3:23 PM
MEADVILLE PA

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