While we’re about to close the books on 2016, we thought it would be nice—and educational—to look back on some of the therapy industry trends, advancements, and hot topics that made headlines throughout the year. Plus, most of these items will impact you and your practice in 2017 and beyond—so, as we look back, don’t forget to look forward. Okay, here we go!
What are those weird suction cups all about?
If you, like many Americans, were glued to your TV during the 2016 Summer Olympics, then you definitely noticed something strange on the backs and torsos of all those elite swimmers—and Michael Phelps, the most decorated Olympic athlete of all time, was no exception. No, these large, red circles weren’t from leeches—but rather, marks resulting from cupping therapy, a therapeutic practice that involves using suction cups to increase blood flow to a patient’s muscles. And while it’s growing in popularity among athletes, cupping therapy also helps people cope with pain, persistent coughs, back problems, and conditions such as shingles. There are three popular variations of this therapy practice—which therapists can perform using either glass or plastic cups. They are:
- Wet Cupping: The purpose of this technique—also commonly referred to as Chinese bloodletting—is to remove “stagnant” blood from the patient’s body. The therapist applies cups to an impacted area of the patient’s body and then removes them after a few minutes. The clinician then makes small incisions and reapplies the cups, drawing blood into them.
- Dry Cupping: The purpose of this technique is to improve blood flow and facilitate faster healing. Unlike wet cupping, though, dry cupping doesn’t involve any incisions, so there shouldn’t be any blood leaving the body. The cups used for this practice—which range from one to three inches in diameter—are applied to the skin before suction is applied.
- Fire Cupping: The purpose of this technique is to treat respiratory diseases, like the common cold, pneumonia, and bronchitis. It’s also a form of deep tissue massage. To treat these common maladies, therapists first soak a cotton ball in isopropyl alcohol, light it on fire, and then quickly dip it into an empty cup. The flaming ball is then removed before it’s applied to the patient’s skin.
The verdict is still out on whether this treatment has any real impact. Some experts view cupping as a simple healing agent—nothing more. “The studies are very preliminary [on cupping]. We cannot say it has proven its efficacy,” said Romy Lauche, a scientist at the University of Duisburg-Essen in Germany.
Is dry needling a safe therapy practice?
The 4-1-1 on Dry Needling
Using needles in rehab therapy may seem antithetical to traditional patient care—after all, therapists pride themselves in providing noninvasive treatment. But, like cupping, dry needling is a form of therapy that grew in popularity in 2016. So, what is it exactly? Dry needling helps treat myofascial pain through the use of a dry needle that goes through the patient’s skin and into muscles in particular areas known as trigger points. Pro-needling therapists tout the practice’s many benefits—which include reduced pain and improved range of motion.
A Pointed Debate
Now, dry needling shouldn’t be confused with acupuncture, as the two treatments differ greatly. But, unlike acupuncture, dry needling has roused a heated debate in the rehab therapy community. Some states have even gone so far as to ban therapists from performing the practice altogether (click here to find out which states do and do not allow dry needling).
Some Workarounds for PTs
But even if you’re legally allowed to provide dry needling, you may still run into some hurdles. Chief among them: Some third-party insurers won’t reimburse for the service, claiming the treatment is “experimental.” Furthermore, the American Medical Association (AMA) has not yet developed a CPT code for the treatment. According to the APTA, “there is no CPT code that describes dry needling nor do any of the existing CPT codes include dry needling techniques in clinical vignettes utilized by [the American Medical Association] AMA in their process to establish relative value units.” Quite the bummer, indeed. So, what are some potential workarounds for rehab therapists looking to provide this service? We recommend asking your payers whether they’ll pay for this service and, if so, which CPT code you should use to bill for it. You also could provide this service on a cash-pay basis and thereby wash your hands of any potential denials entirely.
How do therapists use the new evaluation CPT codes?
As you’re no doubt aware (well, hopefully), come January 1, 2017, rehab therapists must begin using a new set of CPT codes when billing for any patient evaluations or re-evaluations. It’s a topic that garnered plenty of attention throughout 2016—and WebPT just so happened to hold a webinar on these important, looming changes (you can watch a recording of the presentation here). So, start saying your goodbyes now, because after New Year’s Eve, 97001, 97002, 97003, and 97004 are no more. In their place will be a brand new set of CPT codes that are tiered according to complexity. Bear in mind that this change applies to all HIPAA-covered entities and virtually all insurance carriers—not just Medicare. So, there’s no skirting this one.
With this in mind, I would highly encourage you to check out this blog post and this one, both of which offer complete, detailed information on the new CPT codes, including an explanation of how to select the right level of code complexity. I know—this extra legwork may not be a picnic from the outset. However, as we continue to hammer home, the long-term payoff is that you’ll eventually be able to create clearer snapshots of the patients you treat and the care you provide—which could have a more positive effect on future reimbursement rates.
Are therapists really off the hook for PQRS?
The short answer: yes. Medicare released its Final Rule in November and indicated that PQRS is officially no more at the conclusion of 2016. That means that as of January 1, 2017, you’re relieved of your quality reporting duties—sort of (more on that later). Under PQRS, all eligible Medicare providers—including PTs, OTs, and qualified SLPs—had to meet the criteria for satisfactory reporting of certain outcome measures. And although PQRS was never technically mandatory—and, believe us, we received plenty of questions about this throughout 2016—eligible providers (EPs) who didn’t satisfactorily meet reporting requirements were subject to financial penalties. Now, just because PQRS will cease to exist in the new year doesn’t mean EPs are off the hook for any penalties they incurred in previous reporting years. So, if you failed to report satisfactorily in 2015 or 2016, you’ll still suffer a 2% downward payment adjustment on all Medicare Part B payments in 2017 or 2018, respectively. But, as I mentioned above, the elimination of PQRS doesn’t necessarily mean the end of your quality reporting duties—at least not in the long term.
How do therapists continue reporting quality data?
While PQRS is going away, many elements of PQRS will live on as part of the new quality reporting program known as the Merit-based Incentive Payment System (MIPS), which goes into effect January 1, 2017. I can already hear the groans: “You mean there’s another quality reporting program already on the books?!” Well, yes. But, don’t get your tinsel in a tussle just yet. As we previously reported, while PTs, OTs, and SLPs aren’t formally required to join the program until at least 2019, CMS will allow non-eligible providers to participate in MIPS on a voluntary basis during the 2017 and 2018 reporting years. So, if you want to maintain continuity in your quality data-reporting habits, it appears you’ll have the option to do so. Unfortunately, that’s about as much as anyone knows at this point, as CMS has yet to formalize any details on voluntary MIPS participation. Of course, as soon as we know those details, we’ll post them right here on the WebPT Blog.
Is the ICD-10 grace period really over?
A major theme throughout 2016—and one that will certainly carry over into 2017 and beyond—is providers’ duty to always select the most specific diagnosis codes available to support the medical necessity of their services. Coding decisions can sometimes turn into head-scratchers, and providers who were still struggling one year post-transition may have experienced additional difficulty when Medicare’s ICD-10 grace period ended. That period—which began when ICD-10 went into effect on October 1, 2015—officially ended on October 1, 2016 (i.e., ICD-10’s one-year anniversary).
The Dwindling Margin for Error
While the grace period allowed for some coding wiggle room, Medicare and other payers have become less forgiving following the one-year mark. As such, PTs, OTs, and SLPs can no longer expect payment for merely selecting a code from the proper family of codes (a “family of codes” refers to a group of codes falling under the same three-character category). In other words, providers are now subject to the full scope of ICD-10 coding requirements—and that means they must accurately code to the greatest possible level of specificity. Otherwise, they risk claim denials.
The Demand for Specificity
We hate to sound like a broken record, but we cannot emphasize enough the need to code for true, unadulterated specificity. CMS won’t be shy about rejecting your claims. That means you must not only consistently select the most specific code possible, but also ensure your documentation supports your coding decisions—especially if you have to use an unspecified code. On that note, keep in mind that reporting unspecified codes won’t always lead to claim denials. In fact, there are some situations in which reporting unspecified codes is 100% acceptable or even “necessary”—such as “when sufficient clinical information is not known or available about a particular health condition to assign a more specific code.” When in doubt, though, it never hurts to ask—because getting paid for any services you perform is kind of a big deal. And continuing with the theme of specificity, one last note: CMS recommends that providers focus mainly on the codes that affect their practices as well as the clinical concepts behind those codes.
Depending on who you ask, 2016 was kind of a bummer—countless celebrity deaths and non-stop election coverage, anyone?—and many people, quite honestly, can’t wait for 2017. But that doesn’t mean we, collectively, didn’t learn a lot about important industry changes and how to navigate them. Indeed, the end of each year offers a great time for introspection and brainstorming on how we can make the future even brighter. Cheers to a happy and prosperous 2017!
What new industry advancements or regulations caught your eye in 2016? How will some of these changes impact you moving forward? Leave your thoughts in the comment section below.