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

Cloudy with a Chance of Reform: 5 Key Healthcare Forecasts for 2017 - Regular BannerCloudy with a Chance of Reform: 5 Key Healthcare Forecasts for 2017 - Small Banner
  • articleNov 16, 2010 | 2 min. read

    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 …

  • 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 …

  • 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 …

  • articleDec 6, 2010 | 1 min. read

    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 …

  • The 2015 Therapy Cap: Same Story, Different Year Image

    articleNov 18, 2014 | 3 min. read

    The 2015 Therapy Cap: Same Story, Different Year

    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 …

  • 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 …

  • Gifts, Donations, and Discounts: What Medicare Needs You to Know Image

    articleJul 24, 2014 | 6 min. read

    Gifts, Donations, and Discounts: What Medicare Needs You to Know

    The world of private practice physical therapy is certainly competitive, so it makes sense that owners and directors consider every angle when it comes to promoting their businesses. Unfortunately, some of those angles can get you and your practice in hot water with Medicare. Today, I’ll discuss handling gifts, donations, and discounts in a way that doesn’t rile up the big M. But before I launch into that, here’s a legal primer: Stark Law vs. Federal Anti-Kickback …

  • 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 • …

  • 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 …

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