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Midlands Update
We had a great deal of request to get Robbie Leonard PT, MS up to the Midlands area to present on this topic, and we finally have all things coordinated. Robbie is not only a great speaker but is definitely one of our foremost authorities in the state of SC on documentation. So, bring any and all documentation questions and we will get you pointed in the right direction.

"What You Need to Know BEFORE July 1 about Medicare Functional Limitation Reporting and How to Use Outcome Tools in the Outpatient Environment to Meet Medicare Requirements and Drive Practice"


1. Understand the basics regarding Functional Measures Reporting.

2. Identify the required parameters regarding Functional Measures Reporting.

3. Identify standardized outcome tools that can be used in the outpatient setting.

4. Understand how to utilize outcome tools to meet the Functional Measure Reporting requirements of Medicare.

5. Translate functional outcome results into the proper G codes and severity modifiers for functional measures reporting.

6. Utilize outcomes to assist in setting functional goals and assessing progress.

Date: 6-19-13

Time: 6:00 to 7:30 pm

Presenter: Robbie Leonard PT, MS

Place: Arnold Public Health Research Center, 921 Assembly Street, 1st floor auditorium

Parking options: Meter and parking garage

Please email Bob to register 1.5 APTA CEUs will be issued if you stay for the full program. CEUs are free for SCAPTA members, and $10 for non-members.
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Student helps homeless man to try to walkspac again
Nathan Mansell finished his pro bono physical therapy session with 52-year-old Mikell Felder on May 15 by saying "I love you." Felder, a homeless Charleston native who had his right leg amputated just above the knee in 2007, responded, "I love you more." The relationship that the unlikely pair has is held together by a powerful belief in Jesus and a faith that Felder will walk on his own once again. Click on the links below to read more on this story:

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Sequestration and Medicare Advantage Plans
Physical therapists and other health care providers that contract with Medicare Advantage (MA) plans should check their agreements to make sure their payments aren't erroneously being cut by 2% as part of sequestration. The Centers for Medicare and Medicaid Services (CMS) clarified in a May 1 memo to MA organizations and others that sequestration does not mandate a 2% reduction of reimbursement to MA contracted providers. MA plans themselves are subject to the 2% reductions; however, MA plans cannot pass along sequestration cuts to providers unless their contracts with specific providers permit the pass-through. If providers determine that their contracts don't permit these cuts, they should consider challenging the reductions as contrary to their participation and network agreements.

APTA has recently learned that 3 national payers— UnitedHealthcare, Aetna, and Humana—have made announcements related to sequestration reductions for MA plans. UnitedHealthcare announced "Specifically, UnitedHealthcare's Medicare Advantage plans will reduce payments by 2 percent for dates of service or dates of discharge on or after April 1, 2013 to providers whose reimbursements are based upon Medicare reimbursement methodology or rates, including Medicare fee schedules.”

Aetna has sent a letter to providers notifying them of a “sequestration rate adjustment for covered items or services you provide to our MA members on or after August 1, 2013, and will continue for as long as these reductions are applied by CMS."

Humana announced “All non-network providers and network providers who are reimbursed based on the Medicare reimbursement methodology … will have the same sequestration reduction applied in the same manner as CMS.” The announcement does not provide an effective date, but it does provide additional information about identifying these reductions on remittance advices.

APTA is reviewing the CMS memo and payer announcements to develop guidance and resources for members to determine if their practice will be impacted by these payer announcements. The information is being shared now so that members can begin to review their individual contracts with third-party payers to determine and assess the direct impact this may have in their practices. For more information regarding a specific payer's implementation of sequestration, contact your provider representative for that payer.

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Therapy Cap News Regarding ABNs and Payment Liability
CMS recently issued guidance to clarify that in 2013 physical therapists (PTs) must issue a valid Advanced Beneficiary Notice (ABN) to patients to collect out-of-pocket payment from Medicare beneficiaries when Medicare deems services "not reasonable and necessary" after the therapy cap is exceeded. CMS added a frequently asked questions (FAQ) document to its therapy resources page that describes in further detail the rules for using an ABN for services that exceed the therapy cap on or after January 1, 2013, as a result of the Taxpayer Relief Act of 2012. The FAQ reinforces that "If the ABN isn't issued when it is required and Medicare doesn't pay the claim, the provider/supplier will be liable for the charges."

APTA published news of this change on May 3, 2013. PTs with further questions on using ABNs are encouraged to contact CMS at

In related news from CMS, a May 23, 2013, FFS Provider E-news article (Change to Payment Liability for Therapy Cap Denials) notes that remittance advices may incorrectly report that the beneficiary is liable for payment when liability actually rests with the provider. CMS encouraged providers to review therapy cap denials for dates of service on or after January 1, 2013, to refund any inappropriately collected payments from beneficiaries. Additionally, providers should cease to collect payments for therapy cap denials unless the beneficiary was appropriately notified via an Advanced Beneficiary Notice of Noncoverage (ABN).

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Looking for similar articles? Search here, keyword PHYSICAL THERAPY.

House of Delegates update
In this newsletter we have listed six "hot topic" RCs from the 2013 Packet 1 to initiate discussion amongst clinicians in South Carolina. The South Carolina delegation would love to hear your feedback in regards to these or any other RCs from the 2013 House of Delegates.

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Obamacare nullification bill on SC Senate agenda
The State
South Carolina could become the first state in the country to restrict the enactment of Obamacare since the U.S. Supreme Court upheld that law last year.

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Back to basics: Functional limitation reporting G-codes
By Charlotte Bohnett and Erica Cohen
By now, you’ve probably heard plenty on the ins and outs of functional limitation reporting — everything from why an integrated functional limitation reporting solution is the best solution to how to incorporate G-codes and severity modifiers into your documentation workflow. Today, let’s talk G-code basics.

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Testing Period for Outpatient Therapy Services Functional Reporting Ends June 30
The testing period for functional reporting under Medicare ends June 30, 2013. During the testing period, claims without the required G-codes and severity/complexity modifiers continue to be processed and adjudicated by carriers or Part B Medicare Administrative Contractors. After July 1, 2013, claims submitted without the appropriate G-codes and modifiers will be returned unpaid.

More information about functional limitation reporting under Medicare is available at:

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CMS Announces FY2014 Proposed Rules for 3 Settings
CMS published its proposed rule detailing the fiscal year (FY) 2014 changes to Medicare’s prospective payment system (PPS) for acute-care and long-term care hospitals in the Federal Register on May 10, 2013. APTA staff has created a summary of the proposed rule (see Proposed Rule for FY 2014 Hospital Inpatient IPPS under Acute Care/APTA Summaries).

CMS' proposed inpatient rehabilitation facility PPS rule for FY2014 includes a 2 percent increase with an estimated fiscal impact of $150 million. A May 3, 2013, PT in Motion News Now article summarizes additional changes in the proposal. A summary of the proposed rule will be posted on APTA's Medicare Payment and Policies for Hospital Settings webpage.

Finally, the FY2014 proposed rule for skilled nursing facility PPS updates was released on May 1, 2013. This rule includes a 1.4 percent market basket update, with CMS estimating a $500 million increase in FY2014 aggregate payments. The proposed rule also includes CMS comments on the impact of the FY2012 allocation of group therapy minutes, and recommends addition of calendar days of therapy to the Minimum Data Set (MDS), among other changes. A May 2, 2013, PT in Motion News Now article summarizes additional changes in the proposal. A summary of the proposed rule will be posted on APTA's Medicare Payment and Policies for Skilled Nursing Facilities (SNFs) webpage.

APTA will comment on the proposed rules on behalf of its membership. Comments are due June 25 for acute-care and long-term care hospitals, and on July 1 for inpatient rehabilitation facilities and skilled nursing facilities.

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MPPR and Services Provided in Critical Access Hospitals
CMS issued a Change Request, effective October 7, 2013, that revises the amount applied toward a beneficiary's therapy cap amounts when therapy services are provided in a critical access hospital. The requirements ensure the multiple procedure payment reduction (MPPR) is applied to these amounts.
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Heard on the Hill Podcasts
Want to know what is going on in Washington, D.C. related to physical therapy? Have a few minutes to listen to the most up to date presentation from APTA? Check out the monthly APTA Podcasts at for the latest news and updates. We are also looking for more participation from our members that are willing to serve as a 'Key Contact' to a legislator for all districts across the state. If you are interested or want to know more, contact the Federal Affairs Liaison: Aaron Embry, PT, DPT, MSCR at
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Missed last week's issue? See which articles your colleagues read most.

    Physical therapy is a movement profession (
BACL injuries no longer spelling doom for football careers (Newsday)
Obamacare nullification bill on SC Senate agenda (The State)
Physical therapists explain what to expect with physical therapy (The Telegraph)
Trustees: Medicare on sounder footing than last year (USA Today)

Don't be left behind. Click here to see what else you missed.

PTs see strength in industry hiring
Houston Chronicle
There are approximately 185,440 physical therapists in the United States, but in Houston, the demand continues to outpace the number of new grads. By 2020, according to the United States Bureau of Labor Statistics projections, physical therapist employment will grow an additional 39 per cent, adding 77,400 jobs.
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Physiotherapy patient interaction important for pain reduction
According to University of Alberta physical therapy PhD grad Jorge Fuentes, how a physiotherapist interacts with a patient verbally, through eye contact, body language and listening skills is almost as important as the treatment itself. Fuentes found that how physical therapists interact with patients plays a significant role in pain reduction. It's the first time that such non-specific factors of physical therapy treatment have been studied in a randomized controlled study.
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New tool could improve prognoses for musculoskeletal diseases
Science Omega
A new prognostic tool developed by Keele University researchers could help GPs to more accurately predict the disease outcomes of patients with musculoskeletal conditions. By including additional questions within patients' initial consultations, the academics, whose research has been published online in the Journal of the American Medical Association (JAMA), were able to improve upon the accuracy of doctors' own prognostic judgements.
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The Obamacare experiment that's already improving seniors' care, and saving hospitals millions
Think Progress
Hospitals and physicians across the country are teaming up to more effectively coordinate all aspects of Americans’ care, leading to millions of dollars in savings for both providers and the federal government, Bloomberg reports. That's because of an Obamacare experiment that incentivizes hospitals, providers, and medical professionals to coordinate with each other on patient care as part of a unified medical “neighborhood
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Habilitative services under health reform faces uncertainty
Medical XPress
Despite their inclusion as essential health benefits, habilitative services face an uncertain future under the Affordable Care Act, according to a new analysis done at the George Washington University School of Public Health and Health Services (SPHHS).
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Colby Horton, Vice President of Publishing, 469.420.2601
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Nikki Trufant-Wade, Content Editor, 972.910.6810  
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