WebPT Blog - therapy cap
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1 CommentsMar 11, 2013| Erica Cohen
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 way, you can access it wherever, whenever you want. Ready to jump in? Here’s your Medicare Q&A.
(P.S. Are you a first timer to thiswebinar or looking for a refresher? Click here to rewatch the webinar.)
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Feb 19, 2013| Charlotte Bohnett
During CSM 2013, I attended the two-part presentation on fraud and abuse in Medicare. While such stories of the “Rock Doc” in South Beach were very interesting (and shocking!), the presenters stressed that those sensational stories are not the norm. Typically, when Medicare audits rehab therapy practices, it’s primarily due to documentation and billing red flags rather than flat out fraud. Of course, red flags can arise due to negligence (i.e., what Medicare would label as “abuse”).Whether born out of accident or carelessness, you absolutely cannot let non-compliance fly. Medicare means businesses, and they aren’t messing around with audits. Not to mention that you owe your patients the epitome of professionalism, organization, and safety. Let’s discuss.
What are the major red flags?
- Frequent use of the KX modifier (divergent from the norm)
- Billing under one PT provider number rather than each separate enrolled PT
- Billing excessive number of codes per session
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Feb 18, 2013| Erica Cohen
This blog post comes from WebPT writers Charlotte Bohnett and Erica Cohen.Navigating the murky waters of Medicare can be as scary as finding yourself on a lifeboat in the middle of the ocean with a tiger on board—well, maybe not just as scary, especially if you have WebPT to help. We’re filling this month’s blogs with all sorts of valuable and applicable information on everything there is to know about 2013 Medicare. But what better way to get up to speed than with some frequently asked questions.
1.) What is the Therapy Cap?
Under the Balanced Budget Act (BBA) of 1997, Congress placed an annual cap on rehabilitation services through Medicare. That means that Medicare will only reimburse you as the rehabilitation therapist up to a certain dollar amount per patient regardless of services provided.
In 2013, 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. This year, the therapy cap applies to services furnished in private practice, physician offices, skilled nursing facilities (Part B), rehabilitation agencies (or ORFs), comprehensive outpatient rehabilitation facilities (CORFs), and outpatient hospital departments. Unless Congress passes legislation, the therapy cap will no longer apply to outpatient hospital settings beginning January 1, 2014.
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Feb 4, 2013| Erica Cohen
In January, WebPT released the Medicare Allowable Fee Schedule in preparation for the new Medicare Therapy Cap Alerts we’ll launch this month. In short, this new feature will allow you to reproduce your Allowable Fee Schedule within WebPT as published by Medicare. This fee schedule will inform a tracking tool and subsequent alerts so you can see how much of the therapy cap your patients have accrued using your services.As a result of this launch, we’ve gotten quite a few questions about the Medicare Therapy Cap and the changes CMS made this year. Here, we’ll share some Q&A we adapted from the APTA’s Medicare Therapy Cap FAQs:
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Nov 7, 2012| Charlotte Bohnett
Today’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.APTA, CMS, compliance, fee schedule, G code, medicare, policy, PQRS, therapy cap -
Aug 28, 2012| Charlotte Bohnett
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 what they discussed:
- What is compliance? How does it relate to Medicare and medical billing? And why should you care?
- What is the 2012 Therapy Cap?
- Modifiers and How to Use Them
- Manual Medical Review
- How does documenting with an EMR help you stay compliant?
- What is PQRS? How can you ensure compliance with outcome measures? What are the reporting methods?
Want the full kit and compliance kaboodle? Watch the webinar in its entirety below:
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Aug 13, 2012| Erica Cohen
Today’s blog post comes from PT and compliance guru Rick Gawenda, founder and President of Gawenda Seminars and Consulting, Inc. The Middle Class Tax Relief and Job Creation Act of 2012 (HR3630) impacted physical therapists in private practice in terms of the Medicare therapy cap. First and foremost, HR3630 extended the therapy cap exception process through the 2012 calendar year. Secondly, it requires that the Centers for Medicare and Medicaid Services (CMS) apply the therapy cap limitations to hospital outpatient departments no later than October 1, 2012. The therapy cap for hospital outpatient departments concludes at the end of 2012 unless Congress passes additional legislation extending it into 2013.
So how does this affect the private practitioner? Currently, any outpatient therapy a Medicare beneficiary receives in a hospital outpatient therapy department between January 1 and September 30, 2012, does not count towards the $1,880 physical therapy and speech-language pathology cap. However, beginning on October 1, 2012, any therapy a Medicare beneficiary receives in a hospital outpatient department will now count toward the cap. Additionally, any outpatient therapy the Medicare beneficiary received in a hospital outpatient department from January 1 to September 30, 2012, will be applied retroactively to the $1,880 therapy cap limitations beginning on October 1, 2012.
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Aug 9, 2012| Charlotte Bohnett
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 the APTA’s FAQs on the Therapy Cap and KX Modifier, under the Balanced Budget Act (BBA) of 1997, Congress placed an annual cap on rehabilitation services through Medicare. That means that Medicare will only reimburse you as the rehabilitation therapist up to a certain dollar amount per patient regardless of services provided.
In 2012, that annual per beneficiary therapy cap is $1,880 for physical therapy and speech language pathology services combined, and there is a separate $1,880 amount allotted for occupational therapy services.
Note: While the Medicare Advantage plan may apply a $1,880 therapy cap with an exceptions process, many Medicare Advantage plans have chosen not to apply a therapy cap in the past. Please check with your Medicare Advantage plan regarding its payment policies.
Read WebPT cofounder, COO, and PT Heidi Jannenga’s take on the therapy cap in her blog post, “Save the Day the CMS Way.” -
Aug 6, 2012| Charlotte Bohnett
Today’s blog post comes from WebPT cofounder and COO Heidi Jannenga, PT, MPT, ATC/LTo 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 with these changes is crucial if you are treating patients with Medicare insurance. As our fellow superhero Spiderman says, “Whatever comes our way…we always have a choice...It's the choices that make us who we are, and we can always choose to do what's right.” As therapists, we want to do what’s right for our patients, and that means producing excellent documentation that aligns with Medicare’s compliance requirements. Our skillset as therapists includes validating the need for our services, and we can only achieve this through thorough documentation and use of tests and measures to help show progress during the episode of care. EMRs can help to enforce Medicare compliance, while improving workflow efficiency, but ultimately you’re the last line of defense.
