With all of the blog space we’ve devoted to PQRS this month, it’s easy to forget that Medicare’s final rule addresses more than just our favorite four-letter acronym. But buried deep within CMS’s annual 1,000-plus-page behemoth of government jargon is one more major item of interest to those in the PT, OT, and SLP industries: the therapy cap.

First, the good news: in accordance with the Medicare Economic Index (MEI), both cap amounts—the one for occupational therapy and the one for physical therapy and speech-language pathology combined—will increase to $1,940 for 2015 (up from $1,920 in 2014). And, thanks to some eleventh-hour legislative action this past spring, the therapy cap exceptions process remains in effect until March 31, 2015. However, that silver lining might actually be a storm cloud in disguise. Why? Well, because if history is any indication, the most recent therapy cap extension will only give legislators an excuse to put off real reform until next year’s eleventh hour.

If you’re unfamiliar with the therapy-cap saga, here’s the book-jacket version: Although the therapy cap was always meant to serve as a hard limit on Medicare’s annual coverage allowance for outpatient therapy services, Congress has acted to prevent the enforcement of a true cap every year since 1999 (the first year the cap went into effect). That’s how the exceptions process came into being. This process allows therapy providers to treat above the cap when their services qualify as “medically necessary.” And while a semi-flexible cap is certainly better than the alternative, I think most therapy providers would prefer a permanent solution over the yearly scramble to pass a quick fix.

Earlier this year—before legislators put another 365-day Band-Aid on the therapy cap exceptions process—there was a pretty strong push among therapy industry advocates and congressional representatives alike to repeal the cap (as well as the exceptions process) altogether in favor of implementing a permanent solution. But, as in past years, it was too little, too late. And while the movement to nix the cap has continued to gather support—as of September 24, there were 221 bipartisan cosponsors of the House of Representatives bill (HR 713) calling for its removal—it’s going to take a lot more work to get rid of the cap for good.

So, if you’re sick of dealing with the cap, it’s time to put legislative advocacy on your radar. After all, a new crop of congresspeople will hit the hill—Capitol Hill, that is—on January 1, and the sooner you get this issue in front of them, the better our chances of success. Check out this APTA page to learn how you can make your voice heard. Because even though the beginning of the 2015 therapy cap story is the same as the 2014 edition, the ending doesn’t have to be.

Triumph in the Triple-Aim Game: The Healthcare Executive’s Guide to Readmission Reduction, Patient Safety Promotion, and ACO Success - Regular BannerTriumph in the Triple-Aim Game: The Healthcare Executive’s Guide to Readmission Reduction, Patient Safety Promotion, and ACO Success - Small Banner
  • The Complete PT Billing FAQ Image

    articleMay 24, 2016 | 25 min. read

    The Complete PT Billing FAQ

    Over the years, WebPT has a hosted a slew of billing webinars and published dozens of billing-related blog posts. And in that time, we’ve received our fair share of tricky questions. Now, in an effort to satisfy your curiosity, we’ve compiled all of our most common brain-busters into one epic FAQ. Don’t see your question? Ask it in the comments below. (And be sure to check out this separate PT billing FAQ we recently put together.) Questions …

  • Denial Management FAQ Image

    articleMay 26, 2017 | 22 min. read

    Denial Management FAQ

    During our denial management webinar , we discussed the difference between rejections and denials, explained how to handle both, and provided a five-step plan for stopping them in their tracks. The webinar concluded with an exhaustive Q&A, and we’ve amassed the most common questions here. Insurance Issues Claim Quandaries Compliance Qualms Documentation Dilemmas Front-Office Frustrations Insurance Issues We’ve had issues with auto insurances denying 97112 (neuromuscular re-education) for non-neuro diagnoses, even in cases when the patient’s medical …

  • articleNov 19, 2013 | 4 min. read

    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 …

  • Hot Out of the Oven: Highlights of the 2017 Final Rule for PTs, OTs, and SLPs Image

    articleNov 9, 2016 | 8 min. read

    Hot Out of the Oven: Highlights of the 2017 Final Rule for PTs, OTs, and SLPs

    Halloween may be over, but if you didn’t get your fill of scares, I’ve got the perfect activity for you: reading through 1,401 pages of pure Medicare gobbledygook. Screaming yet? (Or should I check back at around page 500?) I kid, of course; there’s no need for you to slog through this year’s extra meaty Final Rule —which details the Medicare fee schedule and other important Medicare regulatory and reimbursement changes for physical therapy, occupational therapy, and …

  • Final Rule 2015: Here’s What You Need to Know Image

    articleNov 6, 2014 | 3 min. read

    Final Rule 2015: Here’s What You Need to Know

    The summary of this year’s Final Rule is hot off the presses, which means that—among other things—we now know the details regarding PQRS 2015. For those who have been following the PQRS saga since the program first came into being in 2007, it should come as no surprise that Medicare has yet again upped the ante for compliance. Based on the fact sheet CMS provided , here’s the scoop on this year’s reporting requirements: Eligible professionals who …

  • CMS’s Final Bow: The 2019 Final Rule Image

    articleNov 5, 2018 | 8 min. read

    CMS’s Final Bow: The 2019 Final Rule

    Last week, the Centers for Medicare and Medicaid Services (CMS) published its 2019 final rule . Clocking in at just over 2,300 pages, the final rule isn't exactly a light read—especially because the legal lingo can be harder to interpret than Shakespearean verse. Luckily, we have the script—with all its twists and turns—decoded and ready for you to review. Here's the synopsis of all the physical therapy, occupational therapy, and speech-language pathology Medicare changes for 2019: Out, …

  • FAQ: Unwrapping MIPS and the Final Rule: How to Prepare for 2019 Image

    articleDec 14, 2018 | 38 min. read

    FAQ: Unwrapping MIPS and the Final Rule: How to Prepare for 2019

    Earlier this week, Heidi Jannenga, PT, DPT, ATC, WebPT President and Co-Founder, and Dianne Jewell, PT, DPT, PhD, FAPTA, WebPT Director of Clinical Practice, Outcomes, and Education, hosted an hour-long webinar that unwrapped the many layers of MIPS and the 2019 physician fee schedule. Unsurprisingly, tearing through the layers of CMS’s latest gift revealed a crush of questions—many of which our experts didn’t have time to fully address. So, we compiled the most frequently asked ones for …

  • The Definitive Medicare Part B FAQ for Outpatient PT, OT, and SLP Image

    articleOct 27, 2016 | 33 min. read

    The Definitive Medicare Part B FAQ for Outpatient PT, OT, and SLP

    In October, we hosted a webinar dedicated to the most common Medicare misconceptions . We received a lot of questions from the audience—so many, in fact, that we’ve organized them all into one huge FAQ. Scroll through and check them out, or use the link bank below to skip to a particular section. The Therapy Cap ABNs Modifiers Supervision Prescriptions and Certifications Cash-Pay Rules and Regulations Re-Evaluations Everything Else   The Therapy Cap If a patient reaches …

  • Common Questions from our Regulatory Roundup Webinar Image

    articleDec 15, 2017 | 19 min. read

    Common Questions from our Regulatory Roundup Webinar

    Earlier this week, WebPT’s own Heidi Jannenga, PT, DPT, ATC/L, and Charlotte Bohnett teamed up to present a webinar detailing the most important regulatory updates that will impact PTs, OTs, and SLPs in 2018. During this hour-long session—which you can view completely free of charge here —our co-hosts covered a lot of legislative ground. And not surprisingly, they also received a lot of audience questions. While we didn’t have time to answer all of those questions live, …

Achieve greatness in practice with the ultimate EMR for PTs, OTs, and SLPs.