the House and Senate passed legislation to bring the nation back from the
"fiscal cliff" that includes 5 important provisions for physical
therapists. The bill has been sent to President Obama for his signature.
Taxpayer Relief Act of 2012 (HR 8) freezes the Medicare conversion factor for
2013 at the 2012 level, averting a 26.5% cut to physical therapists and other
providers under the physician fee schedule, and continues the 1.0 GPCI work
value floor through 2013. The legislation also extends the current 2-tier
therapy cap exceptions process ($1,900 automatic KX modifier process, $3,700
manual medical review, and application of the therapy cap to hospital outpatient
department) for 1 year. Additionally, in a provision that APTA has called "unjustified,
capricious, and poor public policy," the bill applies the multiple procedure payment reduction (MPPR) to therapy services at 50%, up from 20%
for office settings and 25% for facility settings, beginning April 1. APTA estimates
the application of a 50% MPPR policy will reduce payments by approximately 6-7%.
This reduction will be partially offset by a 4% increase that resulted from the
Centers for Medicare and Medicaid Services' (CMS) use of new survey data of
practice expenses conducted by APTA. Coupled together, APTA expects the net
overall decrease for outpatient therapy services to be between 2%-3% beginning
April 1. APTA will update the MPPR calculator on its website in the coming
days. APTA will advocate to stop
the implementation of the MPPR provision.
HR 8 also
postpones sequestration cuts until March 1. Under these cuts Medicare providers
would see a 2% reduction in payment. The National Institutes of Health and
other federal agencies would see reductions of 7%-8%.
Read this statement by APTA President Paul
A. Rockar Jr, PT, DPT, MS, on HR 8. A summary of the legislative provisions and offsets (savings) to HR 8 is available
on APTA's website.
Several other policies of
importance to physical therapists went into effect January 1. Under the functional limitations reporting requirement for Medicare Part B
services, physical therapists must include nonpayable G-codes and
modifiers on claim forms to capture data on the beneficiary's functional
limitations at the outset of the therapy episode, at a minimum of every 10th
visit, and at discharge. To
ensure a smooth transition, the Centers for Medicare and Medicaid Services has
set forth a testing period from January 1 until July 1. After July 1 claims
submitted without the appropriate G-codes and modifiers will be returned
physical therapists who successfully participate in the Physician Quality Reporting System in 2013 can obtain a 0.5% bonus payment in 2013 and 2014 and will avoid
penalties of 1.5% in 2015.
APTA will continue to provide updates and post resources to
help members comply with 2013 Medicare policies.