Many of you have contacted us about the NCD for Cardiac Rehab, specifically the 93797 CPT code and its implication for use with education, counseling, and risk factor modification. We were originally told by Cahaba that these services would be covered under this code since the word “exercise” does not appear in the CPT description and it is clear by the language in 20-10 that CMS recognizes Cardiac Rehab as a program which must contain components other than exercise. Many of our hospitals put processes in place to bill for these components, such as nutrition education, risk factor modification, smoking cessation, and stress management.

We have been informed by Cahaba that the patient must exercise at each session in order to legitimately bill for these services. Dr. Greg McKinney, Cahaba Medical Director, attended a meeting where all of the Fiscal Intermediary CMDs were present. They were in agreement, that although "other" services are covered as part of the Cardiac Rehab (counseling, risk factors, etc.), each session must contain exercise.

As you well know, reimbursement issues surface regularly, and interpretations to the regulations can change. Please check back to the IACPR website for updates.

CMS has revised the language in Manual 100-3 § 20.10. You can read the entire memo here.

As of of June 21, 2006, you can now submit bills for Cardiac Rehabilitation services to CMS. The "MLN Matters" artlcle (MM4401) addressing this is now available on the CMS Website or through your facility's billing office. As the decision was effective 03/22/06, any services performed after that date will be covered. There is an allowable billable period of 18 months after services are performed.

The 2006 Iowa Heart & Lung Games will be held on Saturday, July 15 at Grand View College in Des Moines.  This will be the last year it is being held so we would encourage you to recruit patients to participate.  The Heart & Lung Games offer a unique opportunity for friendly competition among patients with similar health conditions.  The Games include the following:  horseshoes, bowling, prediction walk and bike, golf putt, basketball shoot, and of course the bake-off.  Last year there were some very good baked goods entered.  Yum!!

Please contact Nancy Lane-Gipson at (319)356-8396 or nancy-lane-gipson@uiowa.edu to request an information packet.  The registration deadline is June 19 so don't delay.  It is a lot of fun and we hope to see you there!

Because of the Iowa Revised Nonprofit Corporation Act, our structure of officers and Board of Directors has changed. We are looking for interested members to join our leadership!

If you are interested in being on the IACPR Board of Directors or on a Committee, please let us know. We need to know by May 5 if you have interest in the Board. The current Board will be meeting on May 11 to put a ballot together, we will mail the ballots to you by May 19, and you must return them to us postmarked by June 9. All mailed in ballots will need to be signed or they cannot be counted. We need to have the new leadership in place by July 1. As this is the first year for the restructured board, you can choose if you want a 1, 2, or 3 year term.

Please contact us if you have an interest in joining the IACPR Leadership. We will post the results on the website as soon as they are available.

TIME FOR YOU TO TAKE ACTION!

CONTACT YOUR SENATORS AND REPRESENTATIVES!

HELP GET LEGISLATION PASSED FOR CARDIAC AND PULMONARY REHABILITATION! 

Day on the Hill 2006 was a successful first step toward a legislative fix for cardiac and pulmonary rehabilitation. More than 100 members of AACVPR had over 200 meetings with Senators and House of Representative members to ask for support of two identical bills that have been introduced: S. 1440 to the Senate and HR 4824 to the House of Representatives.

Now we need you. All members of the Senate and the House of Representatives need to be asked to co-sponsor this legislation. Please help make this grass roots campaign effective by contacting your Senators and the House of Representatives in your district.

NEW LEGISLATIVE AND REGULATORY ISSUES PAGE ON AACVPR WEB SITE! 
There is a new resource on the AACVPR web site home page with all the information you need to participate in this push to Congress to pass legislation mandating the coverage of cardiac and pulmonary rehabilitation. It will take you through step by step on how to identify and contact your representatives, a sample letter, disease statistics relevant to your state and/or district, background information to bring you up to date on the issues, and links to follow the progress of this campaign for co-sponsorship of both bills. To access this page, please click here. 

Your Affiliate Reimbursement Contact Person (RCP) in your state or region is familiar and ready to help with this country-wide effort. Please work closely with your RCP so that it is a unified and consistent message that is sent to our legislators.

Please do not include patients at this time. AACVPR will provide further instruction if that strategy becomes necessary. If we all do our part, we can make a difference as professionals who care about our patients.

The Wisconsin Society for Cardiovascular and Pulmonary Rehabilitation will have their Annual Conference on April 28-29 in LaCrosse.

IACPR was awarded a $1000 grant from AACVPR to expand marketing strategies for Cardiac and Pulmonary Rehabilitation programs to Iowa physicians and communities. The plan includes a table-top display, new brochures, and a media package for Cardiac and Pulmonary Rehab week that will be available to IACPR members. The display is scheduled to make it's debut at the Go Red for Women luncheon in Waterloo on February 24, 2006. If you would like your program's brochure displayed at this event, contact Candy Steele.

The nominating committee is looking for candidates for President-elect and Secretary for the next term on the IACPR Board of Directors. If you or someone you know shows leadership qualities and would like to become more involved in our organization, please email Barbara Burmeister (barbara.burmeister@jcph.org) or Contact Us. We're looking for committed leaders to keep our organization strong, but this is an excellent opportunity to develop leadership skills as well. We hope to hear from you!

Review of Medicare Outpatient Cardiac Rehabilitation Provided by Hospitals (A-05-03-00102) http://www.oig.hhs.gov/oas/reports/region5/50300102.pdf

This report consolidates the results of the OIG audits of Medicare outpatient cardiac rehabilitation provided by 34 hospitals. The objective was to determine whether hospitals had complied with national Medicare outpatient cardiac rehabilitation coverage requirements for direct physician supervision and "incident to" services. Twenty-nine of the 34 hospitals in the sample relied on emergency physicians or "code" teams in other parts of the hospital to provide physician supervision when the medical directors were not available, while the remaining 5 hospitals designated a particular physician to provide direct physician supervision. Thirty-two of the 34 hospitals considered the patient's referring physician as the physician whose professional services the cardiac rehabilitation was provided "incident to," while the other 2 hospitals relied on the professional services of a hospital physician. Inconsistent guidance was noteed between the Medicare Coverage Issues Manual, Hospital Manual, and Intermediary Manual.

OIG recommended that CMS: (1) clarify national Medicare cardiac rehabilitation coverage requirements on the provision of direct physician supervision and the physician (referring or hospital) whose professional services the cardiac rehabilitation must be "incident to" and (2) direct fiscal intermediaries to educate hospitals on the clarified national Medicare coverage policy for outpatient cardiac rehabilitation services. In its comments on our draft report, CMS agreed to develop and publish provider education materials to clarify the direct physician supervision and "incident to" provisions of the cardiac rehabilitation benefit.

AACVPR has requested a grass-roots effort to endorse legislation that would move cardiac and pulmonary rehabilitation out of the benefit category of “incident to physician services” and into distinct benefit categories of their own. As you may know, the AACVPR and 3 other pulmonary medicine societies (American College of Chest Physicians, the American Thoracic Society and the National Association for Medical Direction of Respiratory Care) funded a cost estimate from a private economic consulting firm to determine the impact such a move would have on Medicare. The cost estimate was favorable, therefore Senator Mike Crapo (R-ID) introduced bill S.1440, with Blanche Lincoln (D-AR) as original co-sponsor, requesting formal legislation to accomplish the above goal.

It is very important that you contact Senators Grassley and Harkin immediately, asking them to sign on as co-sponsors to S.1440. Click on the emails below to send a letter. Do not sent letters via US postal service - they will take several weeks to arrive as the mail in Washington is screened heavily since the anthrax scare.

http://grassley.senate.gov/webform.htm and http://harkin.senate.gov/

If you like, you can fax your letters, preferably on your hospital's letterhead:

Senator Grassley's fax: (202) 224-6020

Senator Harkin's fax: (202) 224-9369

We have provided a sample letter for you to download and use in drafting a letter on your hospital letterhead that is personal and to the point. We want the letters to come from program directors and medical directors. Scripted phone calls and form letters are less meaningful than a note from the heart that is very personal. Please send an email or a fax of your letter promptly. Grassley told reporters that scripted phone calls and form letters are less meaningful than “a handwritten note or a note from the heart…that’s very personal,” so add something that will be personally from you as an Iowa constituent.

Download the sample letter to your senator here: http://www.iacpr.net/uploads/doc/Sample%20letter%20to%20Senators.doc

After you send the email/fax, call your Senator’s office and request a face-to-face meeting with the Senators or their legislative assistant when they are back in Iowa during their break in August.

Please notify Janie Knipper or Candy Steele when you have sent your email or fax to Senators Harkin and Grassley. Please notify us of any face-to-face meetings or phone calls as well. If you are aware of program directors/medical directors that are not IACPR members or do not have email and would not have received our email alert, refer them to this web page.

Thank you for your support of this important issue.
Sincerely,

Janie Knipper, RN, MA, FAACVPR, IACPR Reimbursement Committee Co-Chair jane-knipper@uiowa.edu
319-356-8396 

Candy Steele, RN, MA, FAACVPR, IACPR Reimbursement Committee Co-Chair steelec@covhealth.com
319-272-2269