Share

CMSToday’s blog post comes from WebPT Senior Copywriters Erica Cohen and Charlotte Bohnett.

We do this every year: waiting and wondering what Medicare is going to do. As the news trickles in—and details are still coming—it all seems as expected so far. So what are the big takeaways? Here is WebPT Co-Founder and COO Heidi Jannenga’s take on what these CMS changes mean for you and your clinic.

First of all, CMS increased the therapy cap by $20 to $1,900 (from $1,880 in 2012) for physical therapy and speech therapy combined and $1,900 for occupational therapy. While this may not seem huge, it’s better than the cuts they once considered imposing. With this ruling, the automatic exemption process will also no longer be in effect after December 31, 2012. That means you will need to appeal based on medical necessity for continued treatment over the cap amount; it won’t be as simple as adding the KX modifier to your billing and supporting it with documentation anymore. Additionally, CMS’s ruling includes a 26.5% reduction to medicare payment rates for physicians, physical therapists, and other professionals. However, if Congress acts by the end of the year (as I think they will), we won’t experience this cut, and they will most likely outline some sort of exception process. Ultimately, we’ll know the outcome for both of these issues as soon as congress comes back into session at the beginning of the new year.

Second of all—and bigger news—effective July 1, 2013, therapists will be required to report new G codes, moving us closer to incorporating function and functional progress within our treatment. You should already be checking (and documenting) functional progress through your short- and long-term goal updates at the 10-visit mark and at discharge, so now it’s really just about linking a G code with that progress. We’ll learn more specifics about the codes and their use in the next few weeks.

For more information, please visit the APTA’s website. Here, you’ll find a detailed summary of the final fee schedule rule starting the week of November 16th, following its formal publication in the Federal Register. We’ll also include a blog post summarizing any new information that becomes available during that week.

That’s Heidi’s take. Now what does the APTA say?

CMS provides a policy and payment update that sets the therapy cap amount on outpatient therapy services and updates payment amounts for Medicare providers. According to PT in Motion News Now, on November 1, CMS released the final 2013 Medicare physician fee schedule rule, which sets the 2013 therapy cap at $1,900 (but notes that the therapy cap exception process expires on December 31, 2012, unless Congress extends it.) This rule also “includes a 26.5% reduction to Medicare payment rates for physicians, physical therapists, and other professionals due to the flawed sustainable growth rate formula.” However, if Congress acts by the end of the year (as it has since 2003), the projected cut will be averted and the “aggregate impact on payment for outpatient physical therapy would be a positive 4% in 2013.”

Additionally, CMS has implemented new functional status codes for physical therapists to report services and updates to the Physician Quality Reporting System (PQRS). As required by the Middle Class Tax Relief Jobs Creation Act of 2012, CMS will collect claim form data about patient functional status for patients receiving outpatient therapy beginning January 1, 2013. This means that “therapists will be required to report new G codes accompanied by modifiers on the claim form that convey information about a patient’s functional limitations and goals at initial evaluation, every ten visits, and at discharge. Beginning July 1, 2013, all claims must include the functional limitation codes in order to be paid by Medicare.”

For 2013, the PQRS reporting period will be based on a 12-month reporting time frame, and the bonus payment amount will be .5%. The 2013 calendar year “will also be used as the reporting period for the 2015 PQRS payment adjustment of -1.5%.” In order to successfully complete the reporting requirements (just as in 2012), you must report “a minimum of three individual measures or one group measure via claims-based reporting on 50% or more of all eligible Medicare patients, or report a minimum of three individual measures or one group measure via [registry-based] reporting on 80% or more of all eligible Medicare patients.”

What do you think of the Medicare rulings? Do you think Congress will act by the end of the year?

ICD-10 Checklist - Regular Banner

webinar Mar 4, 2013

Better Navigate the Murky Waters of Medicare

Between PQRS, Functional Limitation Reporting, and the updated Therapy Cap, there’s a lot going on with Medicare in 2013. Not to fret, though, WebPT’s got your back—and your life preserver. In this month’s webinar, hosts Heidi Jannenga and Mike Manheimer will provide you with everything you need to know to successfully navigate the murky waters of Medicare, including a special section on three functional limitation reporting pitfalls to avoid.

article Mar 11, 2013

February Medicare Webinar Q&A

Today's blogs post comes from WebPT Co-Founder and PT Heidi Jannenga, Marketing Manager Mike Manheimer, and Senior Writers Erica Cohen and Charlotte Bohnett.   Last month’s webinar on Medicare was our most highly attended webinar to date. And that’s really not surprising, because wherever Medicare goes, questions follow. But unfortunately, we couldn’t get to them all live. So we thought we’d put together a blog post will all the great questions you asked and our answers. That …

article Nov 6, 2013

Functional Limitation Reporting in a Nutshell

Hopefully, you’ve been working your functional limitation reporting (FLR) magic for months now, so you’ve got it down pat. If not, you’re probably running into more than your fair share of claim denials. Don’t worry; we’re here to help. Here are some FLR basics in a convenient chestnut shell. (It is almost that time of the year , after all). What is FLR? Beginning July 1, 2013, the Centers for Medicare and Medicaid Services (CMS) require that …

article Jul 3, 2013

Most Frequently Asked Questions From June’s FLR Webinar

Last month, WebPT hosted another fantastic functional limitation reporting (FLR) webinar . If you missed it or simply want a refresher, this post is for you. Here were the most frequently asked questions and answers: Q: How do I handle functional limitation reporting after July 1 for a current patient with no FLR data on record? A: If you haven't submitted functional limitation reporting data on a patient prior to July 1, you should submit it (current …

article Aug 28, 2012

Keep Your Clinic Compliant Webinar Recap

Today's post comes from copywriters Erica Cohen and Charlotte Bohnett. Last week WebPT hosted its most heavily attended webinar ever. Why so popular? Perhaps it was the brow-furrowing topic of compliance, or maybe it was our special guest—physical therapist and compliance expert Rick Gawenda of Gawenda Seminars . Together, Rick, moderator Mike Manheimer, and WebPT co-founder Heidi Jannenga, PT, set out to tackle compliance, making it entertaining, informative, and most importantly, understandable. Here’s a brief snapshot of …

Breakdown of the 2014 Proposed Physician Fee Schedule Rule Image

article Jul 30, 2013

Breakdown of the 2014 Proposed Physician Fee Schedule Rule

Recently, the American Physical Therapy Association (APTA) shared  their highlights of the 2014 Proposed Physician Fee Schedule Rule . This summary boils down the 605-page proposal from the Centers for Medicare and Medicaid Services (CMS) into a 16-page bulleted outline. The breakdown is incredibly helpful, and we definitely recommend you read it. However, we know that not everyone is an APTA Member, and many of you are crunched for time. So, we sat down with our Founder …

article Aug 9, 2012

Top 5 Medicare Compliance FAQs

This blog post comes from WebPT copywriters Charlotte Bohnett and Erica Cohen. Medicare compliance is one very tough nut to crack as is navigating the murky waters of medical insurance billing. We’ve filled this month’s blogs with all sorts of valuable and applicable information on everything from HIPAA to autonomy. But what Medicare obstacles do you grapple with daily? Today, let’s talk the five most frequently asked questions regarding Medicare. 1.) What is the Therapy Cap? According to …

article Aug 6, 2012

Saving the Day the CMS Way

Today’s blog post comes from WebPT cofounder and COO Heidi Jannenga, PT, MPT, ATC/L To all of our Super Therapists working diligently to improve their patients’ functional level and quality of life, the Center for Medicare and Medicaid Services (CMS) has tossed a chunk of Kryptonite into our clinics. As you know, CMS has implemented many changes this year and continues to have the Proposed Rule for prospective payment and data collection pending. Keeping up to date …

article Oct 3, 2013

ICD-10 Questions and Answers

So, you’ve got some questions about ICD-10. We don’t blame you. There’s a lot going on with the transition to these new diagnostic codes―which will occur October 1, 2015―and it’s best to be on your toes. That’s why we put together this handy-dandy list of questions―and, more importantly, answers―to help you stay on pointe. What’s ICD-10? ICD-10 is the tenth revision to the International Classification of Diseases. Check out this World Health Organization article for a complete …

Get exclusive content delivered right to your inbox.