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  • Proposed 2019 Fee Schedule: Goodbye Functional Limitation Reporting, Hello MIPS?

    It's official: the US Centers for Medicare and Medicaid Services (CMS) is proposing that physical therapist (PTs) join the list of providers who must participate in the CMS Quality Payment Program (QPP), which would mean that beginning in 2019 PTs providing services under Medicare Part B must participate in either the Merit-based Incentive Payment Program (MIPS) or an Advance Alternative Payment Model (APM).

    But that's not the only significant change proposed by CMS. In a win for APTA and its members, the proposed rule would also eliminate functional limitation reporting (FLR), a requirement consistently opposed by the association.

    APTA regulatory affairs staff are reviewing the proposed rule and will provide more detail in the coming weeks. Here are the major takeaways so far:

    MIPS-eligible clinicians would include PTs
    PTs, occupational therapists, clinical social workers, and clinical psychologists who furnish services under Medicare Part B would be added to the list of providers required to participate in the MIPS program or, alternatively, an approved APM as part of the QPP. Currently, PTs may voluntarily participate in the QPP; if the proposed rule is adopted, the program would begin for PTs in 2019.

    MIPS requires reporting in 4 performance categories—quality, promoting interoperability, clinical improvement activities, and cost. Providers earn points in each category, producing a total annual MIPS score, which in turn determines whether the providers earn a payment incentive, remain neutral in payment, or be subject to a penalty. Several of the data points must be reported electronically through certified EHR vendors or registries such as APTA’s Physical Therapy Outcomes Registry. The inclusion of PTs comes as MIPS enters its third year of the program.

    (Editor's note: check out this article from PT in Motion magazine to get the basics on MIPS)

    Goodbye FLR?
    The FLR requirement, long-characterized by APTA as an unnecessary burden on PTs and other providers, would be eliminated under the proposed rule. Change or elimination of the FLR requirement was an ongoing target for the association, which provided data to CMS showing that the requirement didn't accomplish the value-based care goals that CMS envisioned.

    Physical therapist assistant (PTA) differential officially established
    Under the proposed rule, CMS would establish 2 new therapy modifiers to identify the services furnished in whole or in part by PTAs or occupational therapy assistants (OTAs) beginning. January 1, 2020. The change, mandated by the Bipartisan Budget Act of 2018, establishes modifiers to be used whenever a PTA or OTA furnishes all or part of any covered outpatient therapy service, and would set the stage for a planned payment differential that would reimburse services provided by PTAs and OTAs at 85% of the fee schedule beginning in 2022. CMS anticipates the creation of a voluntary reporting system for the new modifiers beginning in 2019.

    Payment would get a slight increase
    After applying adjustment factors mandated by the Bipartisan Budget Act of 2018, the proposed fee schedule conversion factor would be increased slightly, from $35.99 to $36.05.

    KX modifier requirements remain
    The permanent fix to the Medicare therapy cap enacted in 2018 included requirements to continue using the KX modifiers for claims that exceeded a threshold, which in 2018, is $2,010 for PT and speech-language pathology (SLP) services combined. CMS also references the targeted medical review process, noting the threshold amount of $3,000. That system would continue, but the proposed rule emphasizes that not all claims exceeding the threshold would be subject to review.

    More alternatives to MIPS
    Providers who elect to participate in the QPP through APMs would be allowed a bit more leeway in the new rule. For example, providers participating in the Medicare Advantage Qualifying Payment Arrangement Incentive (MAQI) demonstration project would avoid MIPS reporting and payment adjustments if they participate in Medicare Advantage arrangements that are "substantially similar" to APMs.

    "The proposed rule contains provisions that, while not unexpected, have some far-reaching implications for physical therapists," said Kara Gainer, APTA director of regulatory affairs. "APTA will be analyzing the proposed rule in more detail and providing more information as it becomes available."

    The association will also be providing comments on the proposed rule by the September 10 deadline.

    Comments

    • PTAs are done. No one will hire them now, much less at 85% reimbursement. And the MIPS vendor cost and time spent it won't be worth taking Medicare patients. Time to close shop and retire!

      Posted by Luke on 7/14/2018 11:39 AM

    • I read in a separate article that the MIPS reporting was for private practice only. Will MIPS be required for hospital based outpatient as well?

      Posted by Pete on 7/16/2018 9:10 AM

    • Guess we'll have to learn how to fabricate MIPS reporting, just like we faked it for the G-codes in order to get paid. If not, time to bail out like Luke suggested.

      Posted by Herb on 7/18/2018 4:15 PM

    • Blue Cross and Blue Shield started this lower reimbursement and it’s been proven that PTA’s are not wanted in the clinic because of lower reimbursement thanks to them. We have already seen the trend in outpatient settings. PT’s are already boasting that they don’t use PTA’s as a marketing ploy, now this finishes it for our careers. Bridge programs are few and far between and hard to access. Thanks CMS and BCBS! APTA, what are you going to do?

      Posted by Troy on 7/18/2018 4:36 PM

    • This specifically states for outpatient services: "The change, mandated by the Bipartisan Budget Act of 2018, establishes modifiers to be used whenever a PTA or OTA furnishes all or part of any covered outpatient therapy service, and would set the stage for a planned payment differential that would reimburse services provided by PTAs and OTAs at 85% of the fee schedule beginning in 2022." let's say for the sake of conversation that an LPTA generates $1000.00/per day in reimbursable rx's this would = $2,050,000 per yr, subtract the 15% PTA/OTA differential you get $1,742,500 per yr. Im not sure this spells disaster for PTA's? Maybe so if outpatient practices have low PTA numbers prior to the enforcement of the above proposed reductions. Continued discussion of any and all implications are warranted and welcomed.

      Posted by Jamie on 7/19/2018 10:35 AM

    • I have tolerated and adjusted to 40 years of regulation, restrictions, bundling, changed terminology, payment strategy reversals and falling reimbursement. In the meantime rent, salaries, billing and vendor/supply costs have gone up. No wonder it is hard to find therapists who want to be partners in private practice. Glad I just retired.

      Posted by John Romero on 7/19/2018 11:37 AM

    • If you take away 15%, in a small margin business like PT, you're just killing off a profession; one of the few well-paying professions which require only 2-3 years at an inexpensive community college. Contact your congressman. This goes against everything our country has become in the last 2 years.

      Posted by Sean Hayes -> =NX`?M on 7/19/2018 12:52 PM

    • I am not sure about PTA's not being hired due to lower reimbursement. I am a Physical therapist with Bachelor's in Physical therapy . All the Outpatient clinics in Plano Texas want to hire PTA's but not PT 's. They are willing to hire PT's with specialization or Doctorate only! Now I am working on getting Geriatric specialization through APTA and review of my application is itself is $525.00. I am debating if to pursue with doctorate or several specializations ? Any suggestions! Brindha Thirunavukkarasu.

      Posted by Brindha Thirunavukkarasu -> =OP_<K on 7/19/2018 1:41 PM

    • Has CMS and APTA worked on standardization of ALL data elements in the definitions of quality, cost, clinical improvement, and interoperability? When providers provide their own unique definitions and ratings, then once again we are in FLR mode with impossible analytics for interpretability. I would much rather have a reasonable DRG payment for OP patient categories that is risk-adjusted for patient severity. Then providers can manage their own metrics and cost to be competitive.Whether a PTA is utilized, or not would be immaterial (subject to state regulations of practice) Also- what about Part B payment in SNF and IP Acute services- are these going to be exempt or included in the new reporting?

      Posted by Ed Dobrzykowski, PT DPT ATC MHS on 7/19/2018 2:40 PM

    • @Pete: The proposed reporting requirements are for physical therapist private practices only at this point.

      Posted by APTA Staff on 7/20/2018 6:46 AM

    • Constant regulation changes and constant uncertainty in reimbursement and cuts that does not match the massive escalation in cost due to EMR and healthcare has forced me to close private practice after 19 years before its to late. We spend so much time with EMR to make sure visit is covered it takes away from patient care. The time it takes to document on all these EMR's are escalating cost of staffing. Reimbursement cuts are not keeping it into account. APTA y

      Posted by Annare Loubser on 7/21/2018 3:46 PM

    • Has anyone seen a notice that PTAs can now be reimbursed by the VA? Here in Oregon I worked hard with a great gal at Triwest and she finally got approval. I asked both VA and APTA to notify all of you but haven't seen anything. So spread the word! Part of the reason PTAs don't pay for themselves is because of all the things they can't do or can do but we don't get paid for. We just hired one and she's doing 6 patients to the PTs 12.

      Posted by Debbe on 7/21/2018 9:11 PM

    • In my practice, I co-treat with my PTA's. This ruling will mean a 15% reduction for all my medicare patients. At the same time the cost for a new EMR required by medicare is going to cripple me. STEP UP APTA. WHAT THE AM I PAYING MY DUES FOR. Do we all stop accepting medicare patients? With these rules I will lose money for treating them.

      Posted by Matthew Wensel on 7/22/2018 8:20 AM

    • We have a significant problem. We have an aging population, and a political institution that believes that having the uber 1% pay less in taxes is more important than health care for our fellow citizens. Medicare does not have enough money to do what it set out to do in '65 and what has been added to it through the decades. We PTs have benefited from that expansion. Hugely. I am in a small practice. 2 PTs and a PTA. Highest cost of living area in the USA. Yet paid by Medicare as if I am in a rural setting with a 30% reduction from my neighboring areas. If anyone can grip about the situation it should be me. I use an EMR. Yes it costs me about $350 a month and I spend more time on charting than ever. Dictation cost me about $600 and was blazing fast. I use FOTO on all clients and that costs me $115 a month. It shapes my educational efforts. It helps me market. It is a pain to track and I spend money on having an aide or reception help fold with it. These are what are required to be in practice. I got over it a long time ago. I think it would be helpful to get behind the spirit of MIPS and APM and see it as a way to increase quality over time and across the brand spectrum of health care. The APTA should not fight Medicare as much as the APTA should get involved with urging socially responsible policies that have a great bearing on our ability to fund and thus deliver health care. Sane tax policy, sane educational policy, sane foreign policy should be as much our goals as a sane regulatory environment for delivery of PT services.

      Posted by Jonathan Holtz on 7/23/2018 10:58 AM

    • This will drastically change the way PT's practice in smaller Rural towns. First there are not enough PT's to cover what is already an under-served area, without PTA's we will really struggle. I am the only PT in a 30 mile radius and have 3 PTA's that are amazing and help me with our small rural communities needs. We are a very busy clinic and without them, I would no longer be practicing , I'm sure because I couldn't keep up. I have been paying APTA dues for 30 years and expect that someone will acknowledge the struggles we already face, let alone this dramatic news. Please don't let this 15% cut to PTA services go through. Our livelihoods depend on it.

      Posted by Denise Ring -> @OP]? on 7/23/2018 2:47 PM

    • The great thing about physical therapy is we are so versatile, inventive and optomistic. Our profession has seen so many changes over the 15 years I have been in private practice and we still survive. The profession will continue to fight and we will survive this any anything else that is thrown at us.

      Posted by Kevin Lacey on 7/24/2018 1:39 PM

    • I’ve read several posts that say MIPS will apply to private practice clinics only. Why do hospitals which have much larger margins always get favorable treatment? Is it a simple matter of lobbyists? I would also argue that requiring direct supervision of PTAs should be eliminated if reimbursement is reduced. I don’t see how it is acceptable to require PT to be present, but not pay PT reimbursement rates.

      Posted by Bill on 7/27/2018 6:54 PM

    • I think Jamie's math is off. IF, and I mean IF, a PTA had a full list and made us $1000 a day, there are 52 weeks in the year times 5 days a week is 260 days times $1000 is $260,000. Minus 15% is $221,000. Subtract $60,000 salary, plus insurance and other benefits, their share of the salary of the billing person and receptionist, heat, lights, insurance, rent.....doesn't come out to $1.7 million in my experience! Then we lose money when the PT owner goes on vacation as the PTA can't treat Medicare and others without the PT present! So the PT owner doesn't even get paid vacation!

      Posted by Debbe on 7/30/2018 6:07 PM

    • Will CMS allow a PTA to see patients with indirect supervision in private practice? With PTA needing direct supervision I hire only PTs.

      Posted by James Adisano on 8/1/2018 5:18 PM

    • @James - Medicare requires direct supervision of PTAs in private practice.

      Posted by APTA Staff on 8/2/2018 7:59 AM

    • Hopefully the APTA and AOTA fight this decreasing reimbursement for PTA's. I agree it could really jeopardize patient access to PT services and use of PTA's.

      Posted by Mark Hyland on 8/16/2018 7:19 PM

    • In a time when opioids have FINALLY been brought to national attention after a quarter of a million lives have been tragically lost, I dont understand how the services of an industry that could do so much more to help address this problem (before it could start) are now being penalized for budgetary concerns. This is a time to de-regulate so there is increased access to conservative treatment methods first. The proposed cut sends the wrong message to the PT industry and how many PTs are going to decide to adjust their services to offset a cut in reimbursement. It is an answer that we may never know until the trend in the volume of deaths experiences a continued growth pattern. It is sad. We are in a very hard hit area of the country and not enough is being done. We have many Medicare recipients coming in for treatment who either: 1) never want to be in the position of needing a pain med 2) are recovering addicts who are desperately trying to manage pain and their addiction 3) are currently on a regimen of pain meds and are seeking help to figure out how to no longer need them. It seems to me that this administration needs to get a handle to how to solve the addiction problem we have in this country before restricting the availability of the first line of professionals who can aid in slowing the use of opioids and maybe even prevent future deaths.

      Posted by Jennifer Hartley on 8/26/2018 7:26 AM

    • LOL!!....over 35+yrs in the profession and look what a disgrace!! ..it looks like the opiod crisis has finally reached the good old folks at Medicare!! Obviously they have no clue what they are trying to accomplish! Emphasis placed on the old mighty dollar and absolutely nothing of a concern for patient care!! "Quality care"???- that has been a catch phrase for decades now...what a joke!!.. shifting revenue from hard working professional individuals to where ever the hell it goes?!!! Unfortunately everything is so out of control that in my belief there is no light at the end of the tunnel!! "Doomed" to put it lightly!! I consider myself an optimist but I draw the line here!! Like many others.. RETIREMENT IS ON THE HORIZON...SOON!! !!!..thank GOD!!...I had enough!!!

      Posted by Vincent on 9/9/2018 11:37 AM

    • I have read that MIPS does not apply to low volume offices. Can anyone tell me what the definition of "low volume" is?

      Posted by Elizabeth Shelly on 9/10/2018 7:41 AM

    • @Elizabeth: Thanks for the question. The proposed low-volume threshold includes MIPS eligible clinicians billing more than $90,000 a year in allowed charges for covered professional services under the Medicare Physician Fee Schedule AND furnishing covered professional services to more than 200 Medicare beneficiaries a year AND providing more than 200 covered professional services under the PFS. To be included, a clinician must exceed all three criterion.

      Posted by APTA Staff on 9/10/2018 1:45 PM

    • For PTs who are sole proprietors who accept Medicare and get paid 15,000 to 20,000 a year by Medicare tops will we be able to continue and what will the reimbursement be and will we still be able to report using the electronic billing for each visit to report? The APTA has been very quite in its support for independent PTs. Any information and support you can give us would be appreciated. Otherwise PT will become nothing but a factory setting and why would people want to be PTs at the doctorate level? Better to become an MD or a personal trainer then.

      Posted by Tara on 9/12/2018 5:41 PM

    • @Tara - thanks for the question! To be excluded from MIPS, clinicians or groups would need to meet ONE of the following three criterion: (1) have $90k or less in Part B allowed charges for covered professional services; (2) provide care to 200 beneficiaries or fewer, OR; (3) provide 200 or fewer "covered professional services" under the Physician Fee Schedule (PFS). CMS has proposed that starting in 2019, clinicians or groups would be able to opt-IN to MIPS if they meet or exceed one or two, but not all, of the low-volume threshold criterion listed above. CMS will define "covered professional services" in the final rule, due to be released in early November, but we are guessing it will be at the unit level of the CPT code. As such, the majority of Medicare-enrolled PTs could probably opt-in to MIPS if they so choose. If a provider chooses NOT to participate in MIPS, the provider can continue to see Medicare patients and bill Medicare, however, there will not be a payment update to the physician fee schedule payment rate after 2019. Please note that MIPS is intended to be a transitional program to help providers better understand and get experience with taking on risk. The goal is to move providers into true value-based payment models, where providers can earn more by delivering high-value care and controlling costs. APTA has been actively advocating for the development and implementation of more rehabilitation-focused payment models, and will continue to do so. For more information about Medicare APMs: http://www.apta.org/Payment/Medicare/AlternativeModels/ Finally, we will be posting MIPS fact sheets to the MIPS webpage in the coming days, but if you have other questions, please check out the webinar and Q&A sessions APTA did with CMS, as well as the APTA fact sheet on MIPS, all of which can be found here: http://www.apta.org/MIPS/

      Posted by APTA Staff on 9/13/2018 8:30 AM

    • Thank you for your response. As a sole practitioner seeing people in their home I meet all 3 non inclusive requirements .The APTA needs to fight for the individual therapists who are working to provide good care to people in need. My APTA dues are up and as I am planning to renew for my 25th year I am wondering why I am doing so if the APTA is fighting for the hospitals and big corporate PT clinics only? Please fight for equal rights for all PT's. The APTA is my only voice and if I have to change and become completely private pay and wellness then there is no reason for me to be a member any longer.

      Posted by Tara on 10/10/2018 5:48 PM

    • APTA is not gonna do sh&$ in regards to protecting PTs or PTAs. APTA is as powerful as a BB gun against a tank. What positive changes have they brought about. Direct access? Nope. Increased reimbursement? Nope. Protecting our PTAs? Nope. They take our dues and we end up in a far worse situation every few years. The DPT title we get is a joke. It is not recognized as anything in the medical community. If anything it hurts us as MDs view us as "wannabe" doctors. Tell me that MD reimbursement is going to be cut by 15% if a PA sees their patient or orders labs/tests. Of course not....but its perfectly OK to cut PTAs reimbursement. Tis profession is a punching bag and a joke. We have zero lobby, no credibility in the medical community, and now a final kick to the balls with our PTAs. Im opening a restaurant and the APTA can kiss my A$$.

      Posted by Robert on 10/15/2018 5:51 PM

    • Gentle Robert. It appears that The Ring it has deceived you. Seriously, is your restaurant going to have its own brew facilities? If so, I'm in!

      Posted by James on 10/16/2018 12:27 PM

    • Actually, Robert, my management team was not surprised by this at all. I haven't looked into it myself, but they state that mid-level practitioners (PAs, CNPs) are also billed at 85% of the MD rate.

      Posted by Angela Curtis -> >OQaCK on 10/23/2018 11:05 AM

    • Spot on Robert - well said! First, depending what State you live in depends upon whether or not a PT has to directly observe a PTA. Some do not have that requirement. Second, if this indeed comes about, Clinics will do one of two things; PT’s will “ see “ all the Medicare patients, or bill that way - period! Lastly, if this does go through, say goodbye to all of the field of Physical Therapy! PTA’s will quit if they do not get a decent salary, leaving the PT to not only Evaluate, but see all of the patients as well!! Not gonna happen!! And the doctoral program is a joke, I knew a girl from the Philippines who got hers online in an 18 month period. You honestly think this makes the profession look better in the medical community? Do you think anyone honestly is going to call you Doctor so and so....not! Good luck to this attempt, and RIP Physical Therapy profession if it does!!

      Posted by Paul on 11/3/2018 8:11 PM

    • Actually, mid-level practitioners (PA's, etc) are reimbursed by Medicare at a lower rate compared to MD billing; they have been for years. While there may be some DPT programs that are a joke, many are not and I can confidently tell you that I am much more prepared now with my DPT to manage direct access compared to ever before! I often tell the MD's exactly what type of imaging to order based on the diagnostics I have performed. Sad, but true. Many MD's certainly refer to DPT's as NRD's (not real doctors). They need to be educated that the profession has improved since the days of the bachelor degree programs when we truly fell under the MD's. I teach to MD's and often teach a little over their heads (which is not that difficult with my subject matter since they have little to no exposure in their routine training) and they do refer to me as Dr. While the APTA/board may not like it, I most often drop the PT after my name (name, PT, DPT) and just list DPT. I have seen the awareness improve of what the DPT actually means by this approach. Heck, even my religion professor in undergraduate was called Dr. MD's can feel threatened because we are in the medical field and and assume that we are claiming to be MD's which we are not or misleading patients to believe that we are physicians, which we obviously are not. If anyone should be ticked off it should be neurologists (real MD's) when chiropractors saying they are chiropractic neurologists. We don't say that we are therapy physicians. That's absurd. That to me is very misleading. The purpose is to acknowledge that many of us now have a doctorate degree. While I don't make any more $ (because the insurance company could care less when it comes to reimbursement), I certainly know more having my DPT compared to my MPT. I find that those PT's that still have a BS or MPT who don't want to pursue a DPT because it won't make them more money, often say that they see no value in having a DPT. I disagree but that is just my opinion for what little it may be worth. I fully agree that our lobbying power is horrible...which is why PT's partnered up with DC's to get dry needling covered. DC's have great lobbying power and can get the job done!

      Posted by Kimberly Fox -> =LW_AI on 11/6/2018 2:00 PM

    • All The changes for Medicare in regards to the PTA’s in lowering reimbursement is not true. From what I can read it will be the same as “Incident to” billing, in that when there is a PT in the office you bill under his provider number and get the same Medicare reimbursement methodology as you do now. The percentage decrease would come into play when there is no PT in the building and then you get the lowered reimbursement. 85 percent of the fee-schedule for part B.

      Posted by Bill maurice on 11/8/2018 2:27 PM

    • SORRY THIS OFF TOPIC, but I felt it necessary to response to Kimberly on the DPT comments... It is thinking like yours that has effected our profession more than the MDs. Explain to us how your DPM is any better than our MPT/MSPT in clinical practice. I have 25 years of experience that going on to a DPT will do nothing to enhance. I don't want to or need to be called doctor to get respect from my patients and or physicians. I too educate my referring physicians on PT specific issues. I too request specific imaging based on my clinical findings. I too recommend surgical interventions when necessary....OH, all that with my lowly MSPT. If you only desire to be called Dr. Then yes go get a DPT, but DO NOT diminish the work of generations of PTs that came before you because now there is a new degree title. As for your undergraduate religion professor, its called a PhD and he deserves to be called Dr. In my opinion, for what its worth, if a PT wants to be referred to as Dr. Go get an advanced degree, known as a PhD. The DPT offers little over the previous Masters programs.

      Posted by Tom B on 11/10/2018 8:48 AM

    • Can you verify that 2019 MIPS is for private practice PTs only? Curious as I am in a hospital based outpatient therapy setting.

      Posted by Kayla on 11/27/2018 10:38 PM

    • @Kayla: yes, the MIPS requirement for 2019 is limited to PTs in private practice.

      Posted by APTA Staff on 11/28/2018 8:26 AM

    • Got to be smart and realize that private practice for us solo guys in going to the way side. Single practitioners with staff of less then 5-7 people are going to suffer because reimbursements will continue to diminished. I tell prospective students to look into the PTA program instead of the PT programs because the debt with the PhD is too great for return on investment. I'm BS "old school" guy and didn't get my PhD because it is actually of no value in getting me reimbursed any more. So I got my training in other specialties to compete in our market - much more bang for my dollar. I could not practice without my PTA. I am a staunch advocate for the PTA and we need them greatly!!! Now in Texas they want to move to a BS program for the PTA's. How stupid can they be - they didn't learn anything from when our profession went to the PhD program(I'm still trying to find that study that determined my BS program from UTMB in Galveston did not meet the needs of the physical therapy profession for the people in need of physical therapy services. HINT: There was no study and no legitimate reason to put students in $100K debt/parents of those kids too!!!!!!!!!!!Stupid because we thought more education was going to advance our profession - I'm still getting a pay cut from the government sponsored program and private insurances. The APTA should have done a better job legitimizing our specialization programs..........oh yeah that doesn't make more money for the already money hungry university programs. Just ask the those prospective PT students who get a degree and don't get into the PT programs what they are doing with that degree in Exercise Science, Kinesiology, Biomedical Science, Sports Medicine, Biology or whatever they degree they needed to get the door open into the PT program. They have no back up plan and now are stuck with a degree they never intended to make a living on. What in injustice to those young kids. Now ladened with debt and not getting into PT school they have to make another plan and go back to school and get a degree that get's them a real job. More money for the university yepper guys - way to look after our kids and put more debt on them and their parents. Ok enough of my soap box speech. I'm not retiring soon and hope that my practice and our profession can survive long enough until I can retire. Walter, PT(nuff said)

      Posted by Walter Shull on 12/5/2018 1:01 PM

    • That is a terrible rule for physical therapy and occupational assistants. They should modify it to only apply that lower reimbursement rate if there is a certain ratio of PT or OT relative to the number of assistants. Do they reimburse less two doctors when using nurse practitioners or physician assistants?

      Posted by Keith Bisesi on 12/11/2018 4:33 PM

    • Unfortunately you can blame the therapy groups that have one physical therapist running around to four different clinics trying to supervise PTA's and 1-to-12 or 1-18 ratios.

      Posted by keith Bisesi on 12/11/2018 4:44 PM

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