Cloud with snow Learn how your practice can weather the flurry of healthcare changes throughout 2017 in our February webinar. Register now.


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?

The PT’s Guide to Billing - Regular BannerThe PT’s Guide to Billing - 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. Questions related to: • WebPT • Modifier 59 • Other Modifiers • Coding • ICD-10 • …

  • 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, …

  • Breakdown of the 2014 Proposed Physician Fee Schedule Rule Image

    articleJul 30, 2013 | 5 min. read

    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 …

  • Functional Outcome Measures Image

    articleNov 28, 2012 | 5 min. read

    Functional Outcome Measures

    Today's post comes from Tom Ambury, PT and compliance officer at  PT Compliance Group , based off this month’s “Compliance Chat” blog post . By now, I hope most of you are using functional outcome measures. If you haven’t started yet, you might want to consider taking the next few weeks to get prepared and begin the process in January of 2013. Why? Let’s start with the fact that physical therapy documentation is coming under greater scrutiny …

  • The Rehab Therapist’s Quick Guide to the 2016 Final Rule Image

    articleNov 4, 2015 | 6 min. read

    The Rehab Therapist’s Quick Guide to the 2016 Final Rule

    November is finally here, which means we here at WebPT can’t stop thinking about a juicy, flavorful, hot-out-of-the oven—Medicare Final Rule. While your tastebuds probably aren’t jumping with joy over the thought of chewing over a bunch of regulatory gobbledygook, the good news is that this year’s final rule shouldn’t be too tough to swallow (and if it is, you can always add more gravy). We’ve already picked out the most important pieces and served ’em up …

  • PT and OT Evaluation Codes Cheat Sheet Image

    downloadDec 21, 2016

    PT and OT Evaluation Codes Cheat Sheet

    As of January 1, 2017, PTs and OTs must use a new set of CPT codes to bill for patient evaluations and re-evaluations. But, it's not a simple swap-out across the board; instead, when coding for initial evaluations, therapists must now select one of three codes, which are tiered according to the complexity of the evaluation. But, what separates a low-complexity evaluation from a moderate- or high-complexity one? And how should therapists go about making their coding …

  • articleNov 6, 2013 | 2 min. read

    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 …

  • articleMar 11, 2013 | 17 min. read

    February Medicare Webinar Q&A

    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 …

  • Functional Limitation Reporting: Flowchart and SmartArt Image

    articleMay 13, 2013 | 2 min. read

    Functional Limitation Reporting: Flowchart and SmartArt

    If you’ve been paying attention to our blog posts , our webinars , and functionallimitation.org for the past few weeks, you might think we here at WebPT have gone a little FLR-crazy. And you’d be right. You see, the latest CMS regulation—functional limitation reporting (FLR)—has some pretty severe consequences for noncompliance. Namely, if you don’t comply, you don’t get paid. I don’t know about you, but that seems like an awful lot of pressure. So, we’ve set …

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