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?

Webinar: 5 Fast and Cheap Ways to Fix Your Clinic’s Marketing - Regular BannerWebinar: 5 Fast and Cheap Ways to Fix Your Clinic’s Marketing - Small Banner

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 4, 2013

What PQRS Could Look Like in 2014

On July 19, 2013, the Centers for Medicare & Medicaid Services (CMS) published the 2014 Medicare Physician Fee Schedule (MPFS) Notice of Proposed Rulemaking (NPRM) in the Federal Register. According to this summary , most of the policies were open for comment until September 6, 2013 and, pending final decisions (which hopefully will occur this month), will take effect on January 1, 2014. The 605-page document contains proposals for policy changes on everything from reimbursements to the …

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 …

article Nov 7, 2013

FLR and PQRS: How Are They Different?

Functional limitation reporting (FLR) and PQRS both fall under the ever-widening umbrella of Medicare regulations, and they both involve outcome measures and data codes. Still, they are completely separate requirements, each with its own set of rules. Confusing, we know. To help you sort out the differences, we’ve put together a short breakdown of each one as well as a detailed compare/contrast chart: The Basics of FLR On July 1, 2013, Centers for Medicare & Medicaid Services …

Blue Cross Blue Shield, UnitedHealthcare, and Other Payers Add FLR to Select Plans Image

article Jul 2, 2014

Blue Cross Blue Shield, UnitedHealthcare, and Other Payers Add FLR to Select Plans

As of July 1, 2013, the Centers for Medicare and Medicaid Services requires that all practice settings providing outpatient therapy services—and billing for those services under Medicare Part B—complete functional limitation reporting (FLR) on all eligible Medicare patients in order to receive reimbursement for their services. From the initial whispers of FLR, we’ve explained that private payers will most likely follow Medicare’s lead , and indeed they have. In the months since FLR became mandatory, a handful …

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 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 …

webinar May 21, 2013

Get Ready for Functional Limitation Reporting

Beginning July 1, 2013, CMS is requiring that you complete functional limitation reporting (FLR) on all Medicare patients in order to receive reimbursement for your services. We know you want to get paid. That’s why it’s crucial you have functional limitation reporting down pat. With that in mind, WebPT will host a special webinar on May 20 to help you get fully prepared for FLR. In this 60-minute session, hosts Heidi Jannenga and Mike Manheimer will explain …

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.