CMS starts to implement PPACA reform provisions

CMS is moving to implement provisions in the the Patient Protection and Affordable Care Act (PPACA). Here's a brief summary of action the agency has taken so far. Look for more news from CMS on the bill over the next few weeks.  

• Expiration of Therapy Cap Exceptions Process - Outpatient therapy service providers may continue to submit claims with the KX modifier, when an exception is appropriate, for services furnished on or after Jan. 1, 2010, through Dec. 31, 2010. For physical therapy and speech language pathology services combined, and occupational therapy services the limit on incurred expenses is $1,860. Deductible and coinsurance amounts applied to therapy services count toward the amount accrued before a cap is reached.
• Extension of the Outpatient Hold-Harmless Provision - The reform bill extends the Outpatient Hold Harmless provision through Dec. 31 to rural hospitals with 100 or fewer beds and to all sole community hospitals and Essential Access Community Hospitals regardless of bed size. 
• Extension of Moratorium That Allows Independent Laboratories to Bill for the Technical Component (TC) of Physician Pathology Services Furnished to Hospital Patients - PPACA extends the moratorium that allows independent laboratories to bill for the TC of physician pathology services furnished to patients in hospitals, effective for claims with dates of service on and after Jan. 1, 2010, through Dec. 31, 2010. Therefore, independent laboratories may now submit claims to Medicare for the TC of physician pathology services furnished to patients of a hospital, regardless of the beneficiary's hospitalization status (inpatient or outpatient) on the date that the service was performed. If an independent laboratory previously submitted a claim for services covered by this provision and the claim was denied, the laboratory may contact its Medicare contractor for further instructions.
• Extension of Reasonable Cost Payment for Clinical Lab Tests Performed by Hospitals with Fewer than 50 Beds in Qualified Rural Areas - PPACA re-institutes reasonable cost payment for clinical lab tests performed by hospitals with fewer than 50 beds in qualified rural areas as part of their outpatient services for cost reporting periods beginning on or after July 1, 2010, through June 30, 2011. This could affect services performed as late as June 30, 2012. If you are a hospital who qualifies, you do not need to take any action. You will receive reasonable cost reimbursement for an entire year, starting with your cost reporting period beginning on or after July 1, 2010.