Share

CMS will make full payment for the therapy service or unit with the highest practice expense value and reduce payment of the practice expense component by 20% in the office setting and 25% in institutional settings for the second and subsequent procedures or units of service furnished during the same day for the same patient.

Based on policy changes required by the Physician Payment and Therapy Relief Act of 2010, the Centers for Medicare and Medicaid Services (CMS) recently issued a Change Request (7050) and MLN Matters article clarifying that the multiple procedure payment reduction (MPPR) for therapy services in the therapy office setting (eg, private practice therapist offices, physician offices) will be 20% instead of 25%. For all other settings (eg, skilled nursing facilities (Part B), outpatient hospitals, etc) the MPPR amount will be 25%. The MPPR policy, which is effective January 1, 2011, will apply to outpatient physical, occupational, and speech language pathology services that are paid under the Medicare fee schedule. Specifically, CMS will make full payment for the therapy service or unit with the highest practice expense value and reduce payment of the practice expense component by 20% in the office setting and 25% in institutional settings for the second and subsequent procedures or units of service furnished during the same day for the same patient. The MPPR would apply to therapy services when multiple therapy services are billed on the same date of service for the same patient by the same practitioner or facility under the same National Provider Identifier, regardless of whether those therapy services are furnished in separate sessions. The reduction applies across disciplines. The work and malpractice components of the therapy service payment will not be reduced. In addition to the MPPR, other refinements to the fee schedule relative value units will affect payment for 2011. The negative impact of the MPPR will be adjusted by the use of the physician practice information survey data and the Medicare Economic Index rebasing. The net impact of these changes combined in 2011 will be -5%.

Source: PT IN MOTION

Webinar: The Modifier Open Forum - Regular BannerWebinar: The Modifier Open Forum - Small Banner

article Nov 16, 2010

Continued Medicare cuts and caps will affect therapy patients and providers in 2011

The American Physical Therapy Association(APTA) is keeping its members informed about continued cuts and caps for Medicare beneficiaries. In an attempt to control cost, Medicare patients continue to see limitations on their service and the hardest hit areas are long-term rehabilitation care and outpatient services. The hardest hit by these cuts are our nation's seniors and disabled and the providers that service them. Payment cuts and caps on services will affect patients and providers in 2011 Medicare …

This Week in PT News, March 28 Image

article Mar 28, 2014

This Week in PT News, March 28

S. 2110 Vote The Senate is scheduled to vote on the Medicare cap this week, so it’s your last chance to contact your local representatives and ask them to vote “yes” for the Medicare SGR Repeal and Beneficiary Access Improvement Act (S. 2110). Find your senator’s contact information here . HR 4302 Vote Yesterday, the House of Representatives passed by voice vote a proposal (HR 4302) to delay for 12 months a scheduled 24% cut to Medicare …

article Nov 19, 2013

Therapy Cap Recap

If you’re a rehab therapist who treats Medicare patients, you’ve got a bevy of rules and regulations to follow and knowing all of them inside and out is a tall order, to say the least. If decoding government legalese isn’t really your thing, don’t worry—we’ve dedicated this entire month to serving up a smorgasbord of digestible, easy-to-understand guides on the important Medicare policies that apply to you. On today’s menu: the therapy cap. As part of the …

article Dec 6, 2010

Phyical Therapists will continue to get paid by Medicare until Dec. 31

A new ruling provdes an update and avoids Medicare cuts for now. Law Extends Current Payment Until December 31 Physical therapists and other health care providers who receive payment under the Medicare physician fee schedule will continue to be paid at the existing 2.2% Medicare payment update through December 31. The Physician Payment and Therapy Relief Act (PPTRA) of 2010, signed into law Tuesday, codifies a modification of the multiple procedure payment reduction (MPPR) finalized by the …

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 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 …

article Jan 10, 2011

Online calculators reflect new medicare fee schedule conversion factor

APTA's online fee schedule calculator now reflects the $33.9764 conversion factor that will be used in 2011. To use these calculators , click here. Updated Fee Schedule and MPPR Calculators Now Available APTA has updated its Medicare fee schedule calculator to reflect the $33.9764 conversion factor that will be used in 2011. The fee schedule calculator provides the payment amount for each CPT code based on geographic location. It does not guarantee that a local contractor will …

The Scoop on PQRS Image

article Nov 18, 2013

The Scoop on PQRS

What is PQRS? The Centers for Medicare and Medicaid Services (CMS) developed Physician Quality Reporting System (PQRS), which mandates that eligible professionals meet standards for satisfactory reporting. If you are not PQRS-compliant in 2014, CMS will assess penalties. However, we do not yet know what the penalty amount is or how CMS will assess it. There also is a chance that CMS will provide incentive payments for successfully completing PQRS, as they did in 2013. Again, we …

webinar Dec 20, 2013

Preparing for PQRS 2014

In December, we hosted a webinar focused on the new PQRS regulations. This session broke down all the rules for 2014 to ensure you’ll be prepared to play by them and therefore not incur any penalties. During this presentation, we: Detailed the PQRS requirements for 2014 Described the different reporting methods Explained how you can ensure you successfully report

Get exclusive content delivered right to your inbox.