NC Medicaid Managed Care plans and NCCRA

As you may be aware the NC Medicaid Managed Care plans kicked off on July 1st.  We wanted to share some information about cardiovascular and pulmonary rehab coverage for these plans but encouraged you to contact your business office regarding your organizations participation with each plan.

In contacting United Healthcare Community Care for a patient we were told that both Cardiac (93797/93798)  and Pulmonary Rehabilitation (G0424/G0239) allow up to 15 sessions of therapy and no pre-authorization was needed.

In contacting Healthy Blue we were told that Cardiac rehabilitation must be pre-authorized and that we could suggested the number of therapy sessions we think are needed and that Clinical Review would either except or indicate the number of sessions allowed.  We were told there is no coverage for Pulmonary or Respiratory therapy.

In contacting WellCare we were told that Cardiac Rehabilitation(93797 and 93798) and Pulmonary Rehabilitation must be pre-authorized but Respiratory Therapy (G0239) did not require pre-authorization.

In contacting AmeriHealth Caritas they tell us that Cardiac Rehabilitation(93797/93798) does not require pre-authorization for participating providers but would require pre-authorization for non-participating providers. They could find no information for either Pulmonary Rehabilitation (G0424) or Respiratory Therapy (G0239) and suggested that those services would require pre-authorization.

We did not check with Carolina Complete Health or EBCI Tribal Option.

And NC Medicaid Direct is continuing with the traditional plan as it has been.

Below is are the links to the Health Plans.

https://ncmedicaidplans.gov/learn/get-answers

Health plans
For health plan questions, or to learn more about covered services, contact the health plan.

WellCare
wellcare.com/NC
This health plan is offered statewide.

UnitedHealthcare Community Plan
uhccommunityplan.com/nc
This health plan is offered statewide.

Healthy Blue
HealthyBlueNC.com
This health plan is offered statewide.

AmeriHealth Caritas
amerihealthcaritasnc.com
This health plan is offered statewide.

Carolina Complete Health
carolinacompletehealth.com
Carolina Complete Health is a provider-led entity offered to people who live in these counties: Alamance, Alexander, Anson, Bladen, Brunswick, Cabarrus, Caswell, Catawba, Chatham, Cleveland, Columbus, Cumberland, Durham, Franklin, Gaston, Granville, Harnett, Hoke, Iredell, Johnston, Lee, Lincoln, Mecklenburg, Montgomery, Moore, Nash, New Hanover, Orange, Pender, Person, Richmond, Robeson, Rowan, Sampson, Scotland, Stanly, Union, Vance, Wake, Warren, Wilson.

The Eastern Band of Cherokee Indians (EBCI) Tribal Option
EBCITribalOption.com
The EBCI Tribal Option is for federally recognized tribal members or others who qualify for services through Indian Health Service (IHS) and live in Cherokee, Haywood, Graham, Jackson or Swain County or in a neighboring county of the 5-county region. As a member of the EBCI Tribal Option, you can still get services from any Medicaid or NC Health Choice provider.

NC Medicaid Direct
bit.ly/NCBeneficiaryPortal
NC Medicaid Direct is for members who qualify.

New DHSR recertification process

Have you received your letter?  DHSR certification renewal will be available electronically!  Make sure you review your letter and directions so you meet the first deadline of this new process which is August 13th!

 

New DHSR certification renewal

We need your help getting this legislation passed!

Your help is needed! We are in the final push to get our Washington representatives to cosign HR 3348 and HR 1956. When Congress returns to DC in the fall we want this legislation to be included in the healthcare package that will be created. Even if you feel that this doesn’t impact you directly it may in the future and it does effect your colleagues.
 
Things that you can do:
If you haven’t already done so, go to https://app.govpredict.com/portal/grassroots/campaigns/llqfcyvp/take_action and send a letter to your representative.
 
Call your representatives office and tell them that you want them to support these bills https://www.house.gov/representatives/find-your-representative
 
Email Stacey Greenway (stacey.greenway@vidanthealth.com) and find out how to directly email the healthcare legislative assistant that we have been working with this year and use the form letter to ask for your representatives support.
 
The time is now! Let’s do this!

OIG report on Cardiopulmonary Rehab 5-2021

The Office of Inspector General (OIG) issued a report of an audit that reviewed their cardiac, intensive cardiac, and pulmonary rehabilitation (CR/ICR/PR) programs. As you may remember there was an OIG audit in 2015 of cardiac and pulmonary services (CR/PR) and identified claims for these services did not comply with Federal requirements.

The objective of this audit was to determine whether CMS regulatory requirements contained sufficient information to ensure that claims for CR/ICR/PR complied with Medicare coverage requirements.  One hospital was selected to review an audit period covering April 2016 through March 2018.

The OIG’s conclusion was that CMS’s regulatory requirements may not be sufficient to ensure providers complied with the intent of the Medicare coverage requirements. More details about specific findings are found in the report.

The recommendation from the OIG was that CMS should revise the regulations to ensure that providers meet coverage requirements. The CMS response to this recommendation was that such changes would require notice and a public comment period and that consideration would be given to CMS’s next steps.

We are uncertain what the next steps will be.  AACVPR is very aware of this issue and we will keep the NCCRA membership aware of any communications or additional information that comes to light.

See a copy of the report here: OIG report 5-2021

Symposium follow up items

We hope that enjoyed this year’s virtual symposium.  There were a few follow up items that we wanted to include that were discussed during the event:

  1.  Article mentioned by Dr. Crouch’s session titled:  AACVPR Guidelines for Pulmonary Rehabilitation 2020-2021: What’s New?
    jama_lindenauer_2020_oi_200034 (1)    jama_rochester_2020_ed_200025
  2. Patient education sheets mentioned by Dr. Sears during his talk entitied: Walk This Way! Psychological Benefits of Exercise in the Cardiac Rehab Setting
    af pt page
    chf 2013 confidence pt page
    coping with trauma pt page 2013
    icd spouse patient page 2009
    pt page covid
    pt page shock
    sexual health and icd 2010
    sexual health with CAD 2014
  3. Dr. King’s slides for his talk entitled: Fundamentals of PAD Rehab: “The Journey of a Thousand Miles begins with a Single Step-Tao”
    PAD slides

Are you familiar with the NCCRA Student Outreach Program?

by Bridget Way

One of the goals of the NCCRA is to increase awareness of our profession. A great way to do this is by reaching out to students and educators across the state at schools that have Exercise Science programs. In 2019, the Membership Committee began presenting at local schools and received wonderful feedback. The pandemic paused our outreach efforts, but we were able to begin presenting virtually across the state a few months later. So far, we’ve presented at Campbell, Shaw, Chapel Hill, Meredith, Mount Olive (2 separate presentations), Appalachian, and Wake Forest.

We want to provide students the opportunity to network with and learn from professionals in the field of Cardiopulmonary Rehabilitation, beyond the regular internships and the annual Symposium. We want to reach students who may have never heard of this field. By giving a presentation or simply talking about what you do, our members can play a crucial role in helping meet these goals.

We created a Google spreadsheet with all the current contact information for each school, along with space to record your information when you pick a school you want to present to. We also created a basic power point presentation that you can modify to meet your needs.  Below is the Google drive link for the sign-up sheet. The power point is posted on the NCCRA website.

https://drive.google.com/file/d/1ahD4IluaTUGyCh295MJtCsrfTz3Qsiwh/view?usp=sharing

School Presentation_generic – Cardiac & Pulmonary Rehabilitation

Final Reminder – deadlines are approaching for membership and symposium registration

Continuing Education Opportunity – earn CEUs!!

 Greetings, NCCRA!  This is a final reminder to register for the 41st NCCRA Annual Symposium…deadlines are approaching!

NCCRA membership deadline (to get discount code for the symposium):  Friday, April 23

http://nccraonline.org/membership/

Symposium registration deadline: Monday, April 26

http://nccraonline.org/event/2021-virtual-symposium/

Home Health and Cardiopulmonary Rehabilitation services

Did you know?
Patients can receive home health services at the same time as being enrolled in cardiopulmonary rehab. As stated by Karen Lui from AACVPR:
“Beneficiaries may leave the home for medical reasons, such as CR or PR services, and still be homebound if leaving requires a considerable and taxing effort. CR and PR are physician services so are excluded from HH consolidated billing rules. In addition, the procedure codes used for CR and PR do not conflict with HH codes because they are for different medical reasons (i.e., diagnoses). “
For more information you can go to:
https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HomeHealthPPS/coding_billing
Services included in the bundled services of HH:  HHCB_db_4-1-2019

41st Annual NC Cardiopulmonary Rehabilitation Symposium: Moving Forward Together

Dear Cardiopulmonary Rehabilitation Professional:

It’s time to get registered for the 41st Annual NC Cardiopulmonary Rehabilitation Symposium: Moving Forward Together in Cardiac, Pulmonary and Vascular Rehabilitation

We are excited to share this great educational opportunity that will enhance your rehab practice!

The symposium will be held over two days:  Tuesday, April 27th from 12:30—5:15 and Tuesday, May 4th from 12:30-5:15  (Log-in at 12:15)

2021 Virtual Mtg Brochure

2021 Symposium Cost:

NCCRA members $20 per day

Non NCCRA members $50 per day

People who renewed their NCCRA membership this year will receive an email containing a discount code that will used when you register for the symposium.  This discount code is a membership benefit and we ask you do not share it with others.
Membership registration must be completed by April 22nd in order to receive the discount code for the symposium http://nccraonline.org/membership/registration/

 

Symposium registration:  https://www.easternahec.net/courses-and-events/65636

To register through the EAHEC registration page, you must create a MyAHEC account or use an existing one if you have it.  A flowchart of this registration process can be found here MyAHECAccountInstructions

The link above takes you directly to the Registration page for the program and you will have the option to choose which session or sessions you would like to attend.

Symposium registration must be completed by noon on 4/26  

We are excited for the event and we hope that you are too!

Thank you Lisa Warren for your service to NCCRA

We would like to take a moment to thank Lisa Warren for her service to the NCCRA as the Nursing Discipline chair.

Lisa is stepping down as discipline chair after serving for the last six years!

Lisa – we appreciate your dedication to the NCCRA and the field of cardiopulmonary rehab.

If you are interested in serving as the Nursing Discipline chair please email Jennifer Simmons at Jennifer Simmons (current NCCRA president) jennicleary@yahoo.com or Butch DeBoever (Executive Director) bdeboo57@gmail.com