This past week healthcare giant Humana announced t. hat it’s falling in line with rules from the Centers for Medicare and Medicaid Services designed to establish an 85% payment differential for therapy services delivered “in whole or in part” by a PTA or occupational therapy assistant. I have 3 small kids. As patients continue to shop around for their healthcare, healthcare organizations need to consider patient engagement strategies that will improve patient retention and customer loyalty. Consistent with CMS, Humana is requiring use of code modifiers in 2020, with no changes to payment until 2022. Additionally, a few of the January 1 restrictions are staying in place, primarily related requirements around use of the 59 modifier/X modifier. An error has occurred, which probably means the feed is down. Page 3 of 13 ICN MLN901705 March 2020. Documentation is key! At least 50% of a group’s NPIs must perform the same activity for any continuous 90 BACKGROUND. The Centers for Medicare & Medicaid Services (CMS) on Thursday announced that it will allow physical, occupational, and speech therapy practitioners to provide Medicare-covered telehealth services as long as a federal coronavirus emergency declaration remains in effect. They are in dire financial predicaments and struggling to continue providing essential rehabilitation and audiology services to their patients, particularly to those who live in rural and underserved communities. It was comprehensive and a good source of useful information. “The fact that CMS changed course so quickly on so many of the most damaging parts of the coding edits is a testament to what can happen when APTA, its members, and stakeholders speak with a unified voice.”, Questions about where things stand in the wake of the CMS change? Here are some of the important details and summary: As stated above, no unexpected changes have been made including the low volume threshold, MIPS eligibility, data collection, or measure scoring. At this time the American Physical Therapy Association and members put forth a quick effort to promote CMS to change this decision. The targeted medical review threshold will be increased from $3,000 back to $3,700 as it was in prior years. However, it is still uncertain how CMS was planning to define what constituted services performed “in whole or in part” by assistants. Heads up! CMS is continuing to emphasize that there is a preference for Outcomes Measures over Performance Based Measures. By Taylor Goldsmith, 08.02.19. For CY 2020, the KX modifier threshold amounts are: (a) $2,080 for Physical Therapy (PT) and Speech-Language Pathology (SLP) services combined, and (b) $2,080 for Occupational Therapy (OT) services. Learn about therapy caps, skilled nursing care, speech-language pathology services, more. Other physical or occupational therapy primary functional limitation, discharge status, at discharge from therapy or to end reporting Compliance Medicare Modifiers 2020 What the rule will require Effective January 1 2020, all therapy services “furnished in whole or in part by” a PTA or a COTA, will be required to include one of the following modifiers: CQ Modifier: Outpatient physical therapy services furnished in whole or in part by a physical therapist assistant. “APTA and its members conveyed that message in large numbers, and in no uncertain terms. CMS BASEBALL BAT STANDARDS 2020-21. There are still issues that are not announced or worked out yet, however this means that physical and occupational therapists will be able to return to billing for therapeutic activities (97530) delivered on the same day to the same patient as PT or occupational therapy evaluations billed under codes (97161, 97162, 97163, 97165, 97166, 97167). 30% for cognitive therapy beginning in 2020. Although the 15 percent payment reduction does not go into effect until 2022, the modifier requirement goes into effect for claims with dates of service on or after Jan. 1, 2020. The proposed requirements for application of the new modifiers for services performed “in whole or in part” by PT or OT assistants are, (how can I say this delicately) crazy! While this is good news for many therapists and companies, there are still many details to be worked out, including the timeline for CMS to notify Medicare Administrative Contractors of the change, and whether it’s retroactive. Well, CMS finalized the rule actualizing that legislation last year … Furthermore, in a recent statement to the APTA, CMS confirmed this change will be retroactive starting with claims … “It’s never easy to undo something that’s been imposed by CMS and is already up and running,” Neas said. The big picture: a proposed 8% cut in Medicare reimbursement for physical therapy providers in 2021 Deep within the proposed 2020 PFS, CMS reveals a plan that puts Medicare beneficiary access to physical therapy at risk by way of an estimated 8% cut to fee schedule reimbursement in 2021. We’re extremely pleased that CMS listened to the case we made and did the right thing for patients.”. Medicare Beneficiaries Expanded Telehealth Benefits During COVID-19 Outbreak. The return to the pre-January 1 coding environment reverses a CMS National Correct Coding Initiative edit that prevented PTs and OTs from billing for therapeutic activities (97530) if any of the PT or OT evaluation codes were billed the same day for the same patient. April 15, 2020 - Congress is putting pressure on the Centers for Medicare & Medicaid Services to give physical therapists and other care providers the freedom to use telehealth during the Coronavirus pandemic.. The chance of payers paying out once a billing error is submitted reduces and, Q: How often can you bill for the telehealth service.  (cumulative time during the 7 days)  Answer:  PT Providers should only bill for telehealth visit to satisfy the total cumulative time spent with the patient during the. CMS has not yet shared details on effective date and the process for implementation of the changes. The letter from Capitol Bridge also states that CMS will provide further information when it becomes available regarding impacted claims. CMS proposed allowing therapy assistants to deliver maintenance therapy in its proposed payment rule for calendar year 2020, released July 11. It is a $30 billion industry with a projected 30% job growth over the next 10 years. The 2020 CMS (Centers for Medicare & Medicaid Services) final rule has been released and there are definitely implications for physical therapy practices. 5 Despite this, many believe this payment reduction won’t have a significant impact on facility revenue since the average length of stay is only 25 days. This expansion is due to an increase in sedentary lifestyles, an aging population, steady growth in employment and early specialization in sports. Method 2: Divide the total time spent providing the service by 10, round to the nearest whole number, and add 1 minute to identify the number of minutes of service that are required to exceed the 10% standard, then apply the modifier as appropriate. Below is an outline of some of the key changes that have implications for occupational therapy practitioners in FY 2021, followed … There are main areas that are of interest to private physical therapy and occupational therapy practices are: If your organization has assistants, you should work on your plan to comply with these requirements right away. Image: Getty Images/PLG From the American Physical Therapy Association Website: “The coding edit CMS imposed on January 1 not only ran counter to best practice in physical and occupational therapy, but was not consistent with CMS’ own stated goals for care,” said Kara Gainer, APTA’s director of government affairs. For physicians, the Cost Category is scheduled to be increased from 15% of the weighting in 2019 to 20% in 2020, 25% in 2021, and 30% in 2022. We know the lifeblood of a practice is the ability to quickly turn claims into cash, doing so accurately and efficiently. Check back here for more simplified explanations of these upcoming policy changes. Nice to study and work at one's own pace online. Let’s say for example, when a PTA or OTA performs all of a service (as defined by a CPT code) in a given visit, all services performed by the PTA would require a CQ modifier in addition to the GP profession type modifier indicating physical therapy services. Focus on Therapeutic Outcomes Inc (FOTO), a Net Health company, announces that it has been approved as a 2020 Qualified Clinical Data Registry (QCDR) by the Centers for Medicare & Medicaid Services (CMS). This past week healthcare giant Humana announced that it’s falling in line with rules from the Centers for Medicare and Medicaid Services designed to establish an 85% payment differential for therapy services delivered “in whole or in part” by a PTA or occupational therapy assistant. This means a score of 45 in 2020 would be the minimum requirement to avoid a negative adjustment to your Medicare fee schedule in 2022. I suspect that many will find themselves having to appeal incorrect claim denials in the upcoming months due to confusion created when rules changes occur.Â, I am hoping that clinicians see this as motivation to work towards encouraging change to the upcoming reduction of payments coming in the next two years for therapy services. On January 24, 2020 CMS announced that it would remove what has been some of the most argued against changes to, for the most part, return to the coding rules used in 2019. 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