Respiratory therapists throughout the United States—particularly those who are members of the American Association for Cardiovascular and Pulmonary Rehabilitation (AACVPR)—can give themselves a big pat on the back for their success in ensuring that the Medicare Improvements for Patients and Providers Act (HR 6331)1 contains coverage for pulmonary rehabilitation (PR) in section 144, The Pulmonary and Cardiac Rehabilitation Act. Many of them have been working on changing the status of reimbursement for PR since the early 1980s, says Lana Hilling, RCP, FAACVPR, coordinator, lung health services at John Muir Health, Concord, Calif. “Some were actually involved before that time,” she adds.
Previous to the recent passage of the bill in July, there had been no national coverage policy for pulmonary rehabilitation services. Most Medicare Administrative Contractors (MACs) had their own Local Coverage Determination (LCD) that listed the criteria required for the patient to qualify for PR, what services were reimbursable, etc, Hilling says. “These varied widely; some states did not have an LCD and were not able to bill for PR services.”
All of that has changed. Lobbyists for the bill were able to demonstrate that there are well-documented benefits associated with PR: fewer emergency department visits, fewer hospital admissions, and decreased length of stay among them.2 Now that the dust has settled and HR 6331 has overcome the hurdle of a presidential veto (House 383-41 to override; Senate 70-26), RTs understandably have questions: When does the coverage go into effect, who is covered, what do they do until the bill goes into effect?
The bill goes into effect on January 1, 2010, and until that time, the MACs still retain control. They can determine and change what is and what is not covered. Some pulmonary rehabilitation programs have been successful using certain Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) codes to get PR services covered, but as the American Association for Respiratory Care pointed out in a recent online news alert,2 “these codes cannot be construed as nationally accepted codes.”
According to the AACVPR, there is still work to do; one action to take is to begin working with MACs and Fiscal Intermediaries to ensure that they understand the bill’s components. To this end, pulmonary societies will be meeting to discuss proposals of codes for the AMA CPT editorial panel to consider. These coding decisions “will impact pulmonary rehabilitation for years to come,” says the AACVPR.3
So, stay tuned. Your involvement in this process is important to ensuring that payment for pulmonary rehab provides the best care for patients.
- Medicare Improvements for Patients and Providers Act (HR 6331). Available at: www.govtrack.us/congress/bill.xpd?bill=h110-6331. Accessed August 28, 2008.
- What’s Next for Pulmonary Rehab Coverage? August 21, 2008. Available at: www.aarc.org/headlines/08/08/pulmonary_rehab.cfm. Accessed August 28, 2008.
- AACVPR Reimbursement Update. Available at: [removed]www.aacvpr.org/%5Creimbursementupdate071608.htm[/removed]. Accessed September 2, 2008.