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. Physical therapy providers, occupational therapy providers, speech-language pathologists, and audiologists have been hit hard by the COVID-19 pandemic. The Centers for Medicare & Medicaid Services (CMS) released the proposed FY 2021 Medicare Physician Fee Schedule (MPFS) Rule and Fact Sheet on August 3, 2020. Watch out for home health and physical therapy consolidation. 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. 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. 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. If similar measures exist in another QCDR, CMS may require that the measures are “harmonized” to eliminate duplicative measures. Weekly News Scan: 2020 CMS Proposed Rule is Here, Looking at Physical Therapy Holistically. On January 1, 2020 CMS implemented a change to coding that prevented PTs and OTs from billing evaluation codes and therapeutic activity and/or group therapy codes delivered on the same day. The courses were so relevant and very clearly written! Make sure your billing staffs are aware of these updates. Sincere thanks! 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. It is clear that CMS is working to increase the weighting of the Cost Category and decreasing the weighting of the Quality Category over time. The exact amount of the cap (sorry, “threshold”, difficult to tell the difference) is yet to be determined by the Medicare Economic Index. Increase the group reporting threshold from at least one clinician to at least 50% of the group beginning with the 2020 performance year, and 2. Here is a brief break down of the most important details. Heads up! 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. Telehealth – 5 Commonly Asked Questions for PT and Occupational Providers, Medical Billing Services – Parkmedicalbilling.com. 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. Documentation is key! CMS Reverses Coding Changes in Response to Physical Therapist Concerns February 18, 2020 In January, we asked for your help in reaching out to the National Correct Coding Initiative (NCCI) Contractor to remove new edits that were made to the NCCI Procedure-to-Procedure (PTP). Check back here for more simplified explanations of these upcoming policy changes. Other physical or occupational therapy primary functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting Code Discontinued01/01/2020. APTA will provide details as they become available.”. Other physical or occupational therapy primary functional limitation, discharge status, at discharge from therapy or to end reporting Medicare changed its payment policy for physical, occupational and speech therapy in skilled nursing facilities Oct. 1, 2019, moving to a new system … ContactÂ, As anticipated, other insurances are announcing they will follow Medicare’s lead. In a January 24 letter to APTA and other associations, Cathy Cook, MD, medical director of CMS coding contractor Capitol Bridge, wrote that “after reviewing this issue more closely, CMS has made the decision to retain the edits that were in effect prior to January 1, 2020.”. Home health and physical therapy providers aren't too happy. Additionally, CMS is proposing two different methods for determining this 10% standard: If this sounds confusing to you, you are not alone! 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. This is a rule is hot of the presses. Required fields are marked *. Check out more often to read more latest news and updates. It was comprehensive and a good source of useful information. CMS Alert! This will be your guide to re-read, analyze and understand every page of the proposed rules. This is the 11 th year that FOTO has achieved CMS-approved registry status and its second year as a QCDR for MIPS, the Merit-Based Incentive Payment System that took effect … 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. Prior to 2020, the APTA advocated for telehealth’s widespread adoption and expansion. Katy Neas, APTA’s executive vice president of public affairs, says that even with the remaining restrictions, the reversal from CMS is a significant one. Your email address will not be published. “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? Additionally, a few of the January 1 restrictions are staying in place, primarily related requirements around use of the 59 modifier/X modifier. “APTA and its members conveyed that message in large numbers, and in no uncertain terms. In that scenario, the CQ or CO modifier is to be applied for those services (or CPT codes) when the time that the assistant is greater than 10% of the total time spent providing the service. Method 1: Divide the total minutes of assistant provided service by the total minutes spent providing the service and round to the nearest whole number. New Assistant Modifiers will be required in 2020, and they would be an adjustment to the Medicare fee schedule for services performed “in whole or in part” by assistants beginning in 2022. The CMS' 2020 Final Ruling is out. 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. HIGH SCHOOL: CMS HS Football Plan 2020-21. 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. You may be aware when Congress passed the Bipartisan Budget Act in 2018 it directed CMS to establish a payment differential for services, provided in whole or in part, by physical therapist assistants (PTA) and occupational therapist assistants (OTA). Contact advocacy@apta.org.”, Clinicians and companies will need to keep a close eye on announcements and changes for a while to avoid making costly mistakes. These new modifiers will effect reimbursement in 2022. Beginning in 2021, QCDRs and Qualified Registries will be required to support multiple performance categories and QCDRs will have additional requirements to “foster improvement in the quality of care”. QCDRs will be expected to eliminate duplication of measures. CMS proposed allowing therapy assistants to deliver maintenance therapy in its proposed payment rule for calendar year 2020, released July 11. Really appreciate being able to complete these hours at home. Learn about therapy caps, skilled nursing care, speech-language pathology services, more. Washington, DC, March 13, 2020 --()-- In an effort to protect vulnerable patient populations from the transmission of the Coronavirus disease (COVID-19), the Alliance for Physical Therapy … CMS has not yet shared details on effective date and the process for implementation of the changes. Highly recommend this course. Under the Coronavirus Preparedness and Response Supplemental Appropriations Act and Section 1135 waiver authority, the Centers for Medicare & Medicaid Services (CMS) COVID-19 Physical therapy continues to be a growing field with a positive outlook as a career path. It gets complex when talking about services performed partly by an assistant and partly by their supervising therapist during the same visit. The reinstated NCCI edits were published by CMS on September 1, 2020 and become effective with dates of service beginning on October 1, 2020. 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). Nice to study and work at one's own pace online. However, we highlighted some of the more important changes: The minimum performance score for 2020 is expected to be increased from 30 to 45 points. 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. 8/5/2020 . The proposed rule didn’t bring a lot of light to the unexpected changes to MIPS. Today, however, the American Physical Therapy Association (APTA) announced the reversal of this ruling, which means that moving forward, PTs, OTs, and ATCs can continue billing these codes together—just as they did in 2019—and they will receive reimbursement when applicable. The fee schedule was announced by the Centers for Medicare & Medicaid Services (CMS) […] Try again later. There is a lot more to understand about MIPS changes, but it is evident that MIPS is a program that is here to stay and successful participation in MIPS will be critical for Medicare providers. CMS BASEBALL BAT STANDARDS 2020-21. Physical therapy and occupational therapy, but not speech therapy, will see payment reductions after 20 days of service in the SNF setting. The rule has a major impact on occupational therapy services billed under Medicare Part B. 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. Subscribe to our newsletter and stay updated with the latest trends and useful, relevant information in billing and practice management space. An overall pleasant experience. Image: Getty Images/PLG The APTA posted “After a concerted effort by APTA, its members, and other stakeholders, CMS relented on the most detrimental parts of its changes to the edits that prohibited payment for certain activity codes if they’re used on the same day as evaluation codes. 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. CMS has not yet shared details on effective date and the process for implementation of the changes. Save my name, email, and website in this browser for the next time I comment. 30% for cognitive therapy beginning in 2020. Online Assessment by Qualified Nonphysician Health Care Professional (E-Visit) CMS had proposed three new Medicare G-codes (G2061-G2063) that describe non-face-to-face, patient- It is clear that CMS is working to increase the weighting of the Cost Category and decreasing the weighting of the Quality Category over time. 2020 Elite Awareness Edition – Violence Recognition and Prevention, Virginia Scientists Working to Connect Survivors of Stroke, At-Home Rehab, Bullying and Violence in the Healthcare Industry, COVID-19, Mask Wearing Prompts Changes in Makeup, Beauty Trends, TikTok Trend Has Users Adding Birth Control Pills to Shampoo, Cytokine Storms Not Causing Lung Damage from COVID-19, Major Study from Boston University One of the First to Examine Long-Term Effects of Vaping, Smartphone App Can Indicate Worsening Asthma, Over 6 Million Doses of COVID-19 Vaccine Available to States by Mid-December, Hackers from Russia, North Korea Targeted COVID-19 Vaccine Makers. At this time the American Physical Therapy Association and members put forth a quick effort to promote CMS to change this decision. 12/1/2020 . If the number is 11%, then the assistant modifier is required for the service. 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. It is a $30 billion industry with a projected 30% job growth over the next 10 years. This expansion is due to an increase in sedentary lifestyles, an aging population, steady growth in employment and early specialization in sports. CHC Treatment & Authorization 2020-21 ... Insurance Claim Form (Espanol) 2020-21. 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