by Denise Williams | News & Views
They say knowledge is power; and when it comes to reimbursement for cardiac rehabilitation (CR) and pulmonary rehabilitation (PR), Susan Flack, RN, MS is somebody who gets that.
Medicare is a complex animal, she acknowledges, with different rules to govern each type of rehab—rules that have morphed significantly over time. On top of that, Medicare administrative contractors (MACs) for the different regions of the country impose additional rules that apply only to their jurisdictions.
As the manager of both CR and PR programs with UnityPoint Health, in both urban and rural locations, Flack has made a point of staying in front of regulatory changes. “I’ve always been interested in the rules and regulations and understanding why we have to follow certain procedures, where it says that, and how Medicare chooses to enforce or require certain things,” she divulges. Importantly, having a solid grasp of concepts and being able to navigate these complexities positions her to guide staff and peers accordingly and with confidence. “If I don’t know the answers when they come to me, where do we go?” she asks.
She and co-presenter Karen Lui, RN, MS are offering CR and PR professionals the opportunity to catch up on the latest regulatory developments, courtesy of a live AACVPR webinar on December 7, 2021. “We want to clarify some things that continue to be confusing in regards to rules and regulations, discuss what’s new and then hopefully arm participants with possible ways to achieve maximum effectiveness and reimbursement in their programs while adhering to the rules,” Flack says.
The pair will cover a good deal of ground in the one-hour session, titled “2022 Medicare Regulations & Legislative Priorities—A Look Ahead.” Topics Flack will discuss include:
- The move from a single CPT code for PR to two.
- A new diagnosis added to PR allowing for more effective treatment of post-COVID patients
- Program management changes, designed to better align how CR and PR programs operate
- Clarification of the difference between “true” PR and outpatient respiratory services, and which diagnoses are appropriate for each category
- The continued trend of low reimbursement in PR
Lui, meanwhile, will cover a number of other topics, among them:
- Finalized rule changes for CR-ICR-PAD taking effect on January 1, 2022
- Virtual rehab and the latest on waivers for when the COVID-19 pandemic ends
- Congressional bills that AACVPR is active with currently
Beyond their webinar, Flack says she and Lui “would both agree that belonging to the AACVPR and having access to its website is paramount to staying in touch and up to date with what’s new” in the regulatory space. She praises the numerous helpful documents and other materials on AACVPR Central, but cautions users of online question-and-answer forums to keep in mind that information exchanged may be accurate but may not necessarily apply to them because of where their site is located.
“It’s important that you know the federal regulations that are going to take effect in 2022,” Flack concludes, “but also know that your own MACs may have additional information and you need to be aware of that as well, because that varies.”
The webinar will take place December 7, 2021 from 12:00 p.m. – 1:00 p.m. CT. Register here.