PDGM Patient-Driven Payment Model (PDPM) applicable to skilled nursing facilities (SNFs), and the Patient-Driven Groupings Model (PDGM) applicable to practitioners working in home health agencies (HHAs), is critical to Association’s mission to advocate for the profession. AOTA wants to hear from you regarding PDGM Share your experience and read the latest survey findings on PDGM. https://www.aota.org/Advocacy-Policy/Federal-Reg-Affairs/News/2020/PDGM-Share-Story.aspx?promo_name=Share-pymt-exp&promo_creative=Advocacy-Policy&promo_position=hero

Humana Follows Medicare Policy and Implements OTA Modifier Humana has issued a national policy change for both its Medicare Advantage and commercial plans requiring the use of the therapy assistant modifiers as directed by the Center for Medicare & Medicaid Services (CMS) final Medicare Physician Fee Schedule (MPFS) rule. https://www.aota.org/Advocacy-Policy/Federal-Reg-Affairs/News/2020/Humana-Medicare-Implements-OTA-Modifier.aspx

Navigating Home Modifications Billing for Medicare-Covered Clients Medicare-covered clients are entitled, under law, to medically necessary services. Occupational therapy practitioners do NOT have the right, under current statutes, to “opt out” of Medicare. Any occupational therapy practitioner, even those who are not Medicare providers, must directly bill Medicare for any medically necessary skilled therapy services provided to Medicare-covered clients. Whether or not to bill Medicare for home modification OT services must be based on the occupational therapy practitioner’s clinical determination of whether the services are medically necessary. https://www.aota.org/Advocacy-Policy/Federal-Reg-Affairs/News/2020/Home-Modifications-Billing-Medicare.aspx

Changes to NCCI Edits Effective January 1, 2020 In late December 2019, AOTA became aware that the Centers for Medicare & Medicaid Services (CMS) accepted two changes to the National Correct Coding Initiative (NCCI) edits effective January 1, 2020 that affect occupational therapy. Therapeutic activities (97530) and therapeutic procedures, group (97150) can no longer be billed on the same day as an occupational therapy or physical therapy evaluation. These are hard edits, and a modifier 59 will not get the services paid. https://www.aota.org/Advocacy-Policy/Federal-Reg-Affairs/News/2020/Opposing-NCCI-Edits-2020.aspx

Interstate Professional Licensing Compact AOTA is working on creating an interstate professional licensing compact for occupational therapy to address licensure portability. The Occupational Therapy Licensure Compact legislation must be passed into law in each state where it will apply. https://www.aota.org/Advocacy-Policy/State-Policy/Licensure/Interstate-Professional-Licensing-Compact.aspx