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  • 7 Jul 2005 12:29 PM | Julie Feirer (Administrator)

    Click here to view the contents of S.1440. You will need to enter the bill number in the search box.

  • 3 Nov 2004 2:37 PM | Julie Feirer (Administrator)

    We are assisting AACVPR in collecting information on the number of cardiac rehab programs that have closed or are in danger of closing. AACVPR and the American Hospital Association will be meeting with CMS in the very near future. If you know of any programs in Iowa that have closed or are contemplating closing, please email Candy Steele, the Cardiac Reimbursement Contact for IACPR, or call her at (319) 272-2269 no later than November 9. We want AACVPR to have the most accurate information possible.

    We have sent emails to all of our members as they are listed in the online directory. If you did not get an email regarding this request, please check your profile and make sure we have your correct email address. Many of them came back as "undeliverable."

  • 7 Apr 2004 2:35 PM | Julie Feirer (Administrator)

    Doug Doorn, CEO of Spencer Municipal Hospital, related his facility’s experience with the OIG audit of their cardiac rehabilitation program. Much of what was found was consistent with findings of other hospitals that also had OIG visits:

    1. Stable angina. Referenced the definition as stated on the Spencer report. Their hospital will no longer be seeing patients who are post PTCA/stent as stable angina patients. Only stable angina patients who are still having anginal symptoms will now admitted to their program. They have provided education to their referring physicians on the criteria for the diagnosis of stable angina, and have had excellent compliance from the physicians.

    2. "Incident to." Stressed the importance of documentation of physician visits, encouraging patients to see their physicians during the course of treatment, and even having the staff call and make appointments for the patients while in the program.

    3. Physician supervision. They are still relying on the Emergency Department physicians for coverage. They were not cited for this. 

    Other considerations: Considering the implementation of a non-Medicare program that is strictly self-pay. This would include both Phase II and Phase III patients. A crucial issue will be whether or not they need to pay a physician to provide supervision.

    CMS Regional Office Representatives (Kansas City) were available via speakerphone. They are well aware that programs have concerns about financial viability. Their belief is that the issues uncovered in the OIG audits are issues that need to be addressed at the national level, so they have asked the CMS central office for assistance with this. Their current recommendation is that hospitals make no sweeping changes to programs until the CMS central office issues guidelines for change.

    Therese Canaday, manager of medical review at Cahaba (Fiscal Intermediary for most of Iowa) explained the importance of correct diagnosis codes (410.12-410.92, V45.81, and 413.9) and limiting number of visits to 36 sessions to avoid a “SuperOp” edit that will automatically deny a claim (100 % of these claims are automatic edits). The time frame of 12 weeks is not as crucial as the 36 sessions. If a patient comes more than 36 sessions, the documentation in the chart and the documentation submitted with the ADR must support the medical necessity for continued services. This should also include a physician’s order. ADR’s that are returned, or appeals that are filed often result in paid claims. Ms. Canaday stated that they are not looking for evidence of physician supervision when conducting medical review. To meet the "incident to" requirement as defined by Cahaba, there must be an evaluation by a physician and an order for cardiac rehab. If the claim does not contain a covered diagnosis, it will be automatically denied but can be appealed with additional documentation. 

    Ms. Canaday relayed the definition of stable angina as stated by Dr. John Olds, FI Medical Director of Cahaba: “Angina that is relatively predictable as to frequency or inciting factors, does not become more severe or frequent, and/or has not been cured by surgery or medication.”

    Her final recommendation to the group was to maintain “status quo” until we have guidance from the CMS Central Office.

  • 1 Apr 2004 2:32 PM | Julie Feirer (Administrator)

    The main discussion will center around the OIG reports on cardiac rehabilitation programs. Representatives from CMS regional office in Kansas will be available to provide their perspective on the investigation and CMS requirements with regard to physician supervision and oversight in the cardiac rehab setting. Spencer Municipal Hospital CEO Doug Doorn will be available to discuss his hospital's experiences during their review and their responses to the OIG.

    We hope to have a good representation at this meeting from our state's compliance officers, as well as cardiac rehab program managers and your IACPR leaders.

  • 15 Mar 2004 2:31 PM | Julie Feirer (Administrator)

    This was an issue for many programs who have AEDs. We contacted Susie Carter, Chair of the AACVPR Certification Committee. She discussed it with her AACVPR Director and the Recertification Committee Chair, Robin Cuffe. Their determination is that the list on Guideline 11.3 (page 202 of the 4th edition of GCR) is a "should" list. They believe that the guidelines say that the "program services are dependent on the particular site at which the care is being delivered". Having a pacemaker with each defibrillator may actually be based on the individual institution's policy as well. As long as the staff is trained to utilize the AED until the code team or the EMS arrives, the AED should be adequate.

  • 3 Mar 2004 2:29 PM | Julie Feirer (Administrator)

    With a goal keeping you informed in a more timely fashion, we are looking forward to an entirely web-based newsletter. We will be able to update articles and aouncements throughout the year instead of only twice a year.

    We are looking for four energetic regional editors to gather news and write articles to be laced on the website. This will broaden our news base and give a wider forum to all the talented and informed Cardiopulmonary professionals we have in Iowa. Join us in sharing our expertise and improving our profession.

    Contact Us to let us know if you're interested in the editor positions.

    There will be a printed mini-newletter sent in February and more on this venture at the Annual Meeting in April - we hope to see you in Sioux Falls!

  • 27 Feb 2004 2:28 PM | Julie Feirer (Administrator)

    According to the staff at Wellmark Provider Services, Wellmark BC/BS allows up to 36 sessions for Cardiac Rehab. In addition, all diagnosis restrictions have been removed. You should verify with BC/BS that cardiac rehabilitation is a benefit that the patient's group has included in the benefits package. These changes were effective 11/13/01.

  • 30 Sep 2003 2:26 PM | Julie Feirer (Administrator)

    Cardiac Rehabilitation and physician supervision 

    The following question was submitted to Cahaba GBA; the response as stated by Julie Mahony follows:

    Must the physician be in the room when cardiac rehabilitation services are performed or may the physician be in the building, or on the campus at the time of service? Would a 24-hour ER physician meet the requirement? Please let me know how Cahaba is interpreting this statement.

    Cahaba GBA Response:"According to CMS Pub.6, the Coverage Issues Manual, Section 35-25, cardiac rehabilitation programs may be provided either by the outpatient department of a hospital or in a physician-directed clinic. The facility meets the definition of a hospital outpatient department or a physician-directed clinic, i.e., a physician is on the premises available to perform medical duties at all times the facility is open, and each patient is under the care of a hospital or clinic physician. Services of nonphysician personnel must be furnished under the direct supervision of a physician. Direct supervision means that a physician must be in the exercise program area and immediately available and accessible for an emergency at all times the exercise program is conducted. It does not require that a physician be physically present in the exercise room itself, provided the contractor does not determine that the physician is too remote from the patients' exercise area to be considered immediately available and accessible. An example of where the physician may be considered immediately available and accessible would be the presence of a physician in an office across the hall from the exercise room who is available at all times for an emergency. The presence of a physician in a building other than that containing the exercise room does not meet the requirement that the physician is immediately available and accesible. In reference to the ER physician, would this physician be in the same building? Also, consider whether the physician would be available at all times, even while treating a patient in the ER.

    Addendum, January 2004: Dr. John Olds, Medical Director of Cahaba GBA has informed us that a non-physician provider (ARNP, PA) will not suffice for the onsite supervision of cardiac rehabilitation services. This supervision must be either a MD or DO.

  • 10 Sep 2003 2:24 PM | Julie Feirer (Administrator)

    A FREE one-hour telephone training seminar that focuses on "New Resources to Help Patients with Angina" will be held on the following dates:

    • Thursday, October 9, 12-1 PM
    • Tuesday, October 14, 11AM-12PM
    • Monday, October 27, 8-9 AM
    • Wednesday, October 29, 8-9PM
    • Wednesday, November 5, 12-1 PM

    1.0 CEU Credit available 

    A patient education series, "Get Tough on Angina" , training manual, patient handbook, slides and script provided.

    For more details and to register, visit their website: www.pcna.net or call 608-250-2440.

  • 18 Jun 2002 2:17 PM | Julie Feirer (Administrator)

    AACVPR has awarded recertification to several Iowa Cardiac and Pulmonary Rehab programs. These programs were among the first in Iowa to be certified 4 years ago. Congratulations to the following programs:

    Davenport - Genesis Medical Center Cardiac Rehab


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