1. Alabama Advocacy for Cardiac & Pulmonary Rehabilitation

2. First I have to brag…
Jennifer Murphy, Kathe Briggs, Stacey Jones, Jeanne Carlson
Your voice in Washington, DC at DOTH
Very effective requesting a bill that will allow CR & PR to remain under hospital outpatient reimbursement and NOT decrease by 40% if located off-campus
Thanks for those who sent letters-it matters
Thanks to Todd Brown & Anita Jones for leading Alabama push on this issue
GRQ, LLC
4/5/2019

3. Site Location-Good Intentions
Section 603 of the Bipartisan Budget Act (BBA) of Reason for the need
Provider-Based Departments (PBD) that move to off-campus location are paid under Physician Fee Schedule (PFS)
Hospital PBD established off-campus prior to are “excepted” (grandfathered)
You may not be “safe”
Hospital outpatient services moved or established at an off-campus location after that date are “non-excepted”
GRQ, LLC
4/5/2019

4. Site Location-Unintended Consequences
Medicare data illustrate hospitals are NOT purchasing MD practices for CR/PR revenue
AACVPR proposes a bill that exempts any hospital off- campus services under a certain financial threshold would be reimbursed per outpatient (OPPS) and NOT per physician fee schedule (PFS)
CR & PR located or established on-campus are NOT affected by Section 603
Are you sure you’re safe?
GRQ, LLC
4/5/2019

5. 2019 Medicare Reimbursement Rates
Pulmonary Rehab–G0424 & SET for PAD–93668
Hospital outpatient setting
On campus $ 56 (OPPS rate)
Off campus-excepted location $ 56? (OPPS rate?)
Off campus-non-excepted $ 23 (PFS rate)
Physician office setting $ 23 (PFS rate)
GRQ, LLC
4/5/2019

6. 2019 Medicare Reimbursement Rates
Respiratory Care Services - G
Hospital outpatient setting
On campus $ 32 (OPPS rate)
Off campus-excepted location $ 32? (OPPS rate?)
Off campus-non-excepted $ 13 (PFS rate)
Physician office setting $ 13 (PFS rate)
GRQ, LLC
4/5/2019

7. 2019 Medicare Reimbursement Rates
Cardiac Rehabilitation
Hospital outpatient setting – & 93797
On campus (both codes) $ 118 (OPPS)
Off campus-excepted location $ 118?
Off campus-non-excepted $ 47 (PFS)
Off campus-non-excepted $ 24 (PFS)
Physician office setting $ 47 (PFS)
Physician office setting $ 24 (PFS)
ICR is paid per hospital outpatient rate whether on or off-campus
GRQ, LLC
4/5/2019

8. Off Campus Provider-Based Departments (PBDs)
Campus: defined in 42 CFR
“Physical area immediately adjacent to provider’s main buildings…that are not strictly contiguous to main buildings but are located within 250 yards of main buildings, and any other areas determined on an individual case basis, by CMS regional office, to be part of provider’s campus.”
GRQ, LLC
4/5/2019

9. Off Campus Provider-Based Departments (PBDs)
Your legal-compliance dept is acutely aware of Section 603 and campus definition, but may not be aware of the devastating payment implications for CR/PR
For , it appears CMS may have changed payment calculation for some off-campus outpatient services to lower $ amount
American Hospital Association lawsuit has filed suit against CMS on Section 603.
You WILL soon be asked to participate in AACVPR and Alabama advocacy efforts to correct this negative situation for CR, PR, & SET
GRQ, LLC
4/5/2019

10.
How a Bill Becomes a Law

11. AACVPR 2019 Day on the Hill Highlights

12. SACPR Goes to DOTH
Washington DC
March 3-6, 2019