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  • Final 2015 Physician Fee Schedule Rule Announces 1% Payment Rise for PT, Increase in PQRS Reporting, Delay of VM for PTs

    Note: This version corrects an earlier PT in Motion News post that described the 2.0% PQRS penalty as being implemented in 2016. That penalty will be put in place in 2017.

    The final 2015 Medicare physician fee schedule rule released by the Centers for Medicare and Medicaid Services (CMS) includes an aggregate increase in payment for physical therapy services of 1%--provided Congress stops implementation of a payment cut due to the flawed SGR formula by March 31. In addition, despite objections from APTA and other organizations, the new rule increases the number of Physician Quality Reporting System (PQRS) measures required for reporting of physical therapists (PTs) in private practice and other health care professionals to as many as 9.

    The new PQRS rules were opposed by many other professional health care provider organizations and APTA, which provided CMS with comments when the rule was first proposed.

    The PQRS change will increase the number of individual measures required to be reported in order to avoid the 2017 2.0% PQRS penalty, from 3 to as many as 9, depending on whether the provider is using claims ( 6 measures available for 2015), or registry (9 required, or as many as apply to the provider). As in 2014, providers must report on at least 50% of eligible Medicare patients.

    Other changes include:

    • The 2015 therapy cap will be $1,940, up $20 from the 2014 cap.
    • If Congress fails to act before March 31, 2015, the process for exceptions to the therapy cap will end, including the $3,700 manual medical review process.

    In other rules announcements, CMS issued final rules on the methodology for adjusting the DMEPOS feel schedule payment amounts, and the establishment of alternative payment rules for a phase-in of a competitive bidding program.

    APTA will post detailed summaries of the new rules in the coming weeks.

    Visit PT in Motion News for more information on recently-released rules from CMS, including the 2015 outpatient prospective payment system and home health prospective payment system.


    • For the 2015 PQRS program, doesn't that impact your 2017 payment if you do not successfully report and not your 2016 payment as is stated above?

      Posted by Rick Gawenda -> =IY`?L on 10/31/2014 8:28 PM

    • "The PQRS change will increase the number of individual measures PTs are required to report". Up to 9? Is it really worth the 2%? We will be spending more time gathering and providing free data (that is likely unrelated to the reason the patient presented in the first place) than the time actually face to face with the patient. Wouldn't it be interesting if all affected PTs, OTs and STs choose not to participate and just ate the 2%? Would MDs, DOs and RNs then be required to provide this information? Hospital PTs?

      Posted by Gary on 10/31/2014 10:45 PM

    • Reporting on PQRS is not always done for free. It involves assessing patients self-care management skills which we all should be doing anyway. PQRS questions (e.g. have you have any falls, had any pain, had any medication changes since your last PT visit?) creates the opportunity to assess, educate, and make plans to address these areas as needed. It is a way for Medicare to help us become more consistent in our focus and in the care we provide and language we use to document our care of complex patients. 97535 is the selfcare management code to document the time spent on addressing PQRS topics that takes 8 mins or more. Some days the questions may take less than a minute to answer and sometimes these questions may take longer because of changes occurring in between visits. The 2% helps "a little" pay for the biller's time to input this data to Medicare which I wish was more compensatory with the actual billing time involved.

      Posted by Lise McCarthy on 11/3/2014 3:43 PM

    • Really too bad that PT did not get included in the incentive programs for set up of our EMR's. It seems as though PQRS would be nearly impossible to document, track and report manually. Maybe since we're only going to receive a 1% increase, when our utilities have gone up 30%, our rent increased 10% and our employee health insurance jumped 40% in 2012 and 10% annually since then we could get some help paying for our EMR. Somehow we need to find a means of survival. Diversification has helped, but soon we'll be doing facials with our lasers and ultrasounding fat away to make a living.

      Posted by Betty Fackler -> @KQ\A on 11/3/2014 10:47 PM

    • I agree with you, Betty, that is grossly unfair that Congress has not yet allocated funds for use to address the time and financial outlay for PTs using any EHR system. I would be interested to know if APTA has/will do anything to address this unfairness by working towards getting PTs included in the payment incentives given to other practice owners.

      Posted by Lise MCarthy on 11/5/2014 2:38 PM

    • The big elephant in the room is that the majority of Part B therapy billed by PT/OT/SLP is not subject to PQRS: hospitals, SNFs (Part B), rehab agencies, and CORFs. These providers do not have to report, and are not subject to a penalty payment reduction. So the question - is it really about quality?

      Posted by Nancy Beckley on 11/10/2014 9:52 AM

    • As a new practice owner, I use WebPT and I paid to add the PQRS to be compliant. I could not predict what eprcentage of patients would be back patients this year, so I chose to answer all the other questions. These PQRS questions and tests can take at least15 minutes away from my evaluation time. As the owner I just schedule more time around evaluations since my schedule has not gotten full and I have this option. I am highly considering dropping PQRS and taking the deduction in future years.

      Posted by iolanthe culjak, PT on 11/17/2014 10:30 AM

    • Iolanthe, Congratulations on your private practice!! I wish you every success!! Please consider billing Medicare not only for your non-timed evaluation report but for 1 unit of 97535 for every 15 min block of time it takes for you assess patient self-care management skills/needs and plan for interventions related to PQRS. If it takes less than 7 mins Medicare should not be billed; you really should make a claim to be paid for this time, every time it is appropriate. I use Practice Fusion as my EHR; it's free and Medicare-certified, and not perfect. Again, best wishes!!

      Posted by Lise McCarthy on 11/20/2014 12:34 PM

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