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    APTA Clarifies Impact of MPPR in Updated FAQ

    APTA has updated its Medicare Physician Fee Schedule FAQ to clarify the impact of the multiple procedure payment reduction (MPPR) on payment for therapy services.

    Set to be implemented on April 1, the provision applies the MPPR to therapy services at 50%, up from 20% for office settings and 25% for facility settings. APTA estimates the application of a 50% MPPR policy will reduce payments by approximately 6-7% in aggregate for outpatient therapy services. This reduction will be partially offset by a 4% increase in practice expense that resulted from the Centers for Medicare and Medicaid Services' use of new survey data of practice expenses conducted by APTA. The impact of the MPPR reduction on individual practices and facilities will vary depending on the CPT codes billed and the typical duration of the therapy sessions. To determine the impact on your practice, refer to APTA’s MPPR calculator, which can be used to determine payment rates for 2012 and 2013.

    APTA will advocate to fix this flawed policy. The association soon will call on APTA members to help in this effort.


    Comments

    So...would Medicare not have us treat beneficiaries for free or at a loss? That is the way this is trending and does not take into account the additional time and practice expense devoted to the functional reporting policies. I am at a loss...and so will be my practice!
    Posted by Greg Given on 1/5/2013 11:37 AM
    I'm sure when we first went to using RVUs, there was alot of discussion on how the PE value was determined, whether PTs would normally use one code or 4 during a standard treatment. If it was established based on several codes being used, then that's the way it should stay. I don't know why the current administration can't look at the history of the codes and the way they were originally set up and leave it there. As far as going to a "new" old system where we are paid a set fee for a visit, again, let's look back to history. When we first started our clinic we were charging a straight $50 or $60/visit. Then it all changed to seperate codes so we were not under or over paid! Why go back to the old broken system that didn't work! There's too much trying to control what we bill for based on diagnosis and condition of the patient by some bureucrat somewhere. Why not let the doctor and the PT decide what's best for the patient and pay us fairly for what we do so we can stay in business!
    Posted by Debbe Klaja on 1/5/2013 12:39 PM
    When I started in P.T. in 1962, private practices were a rarity, home visits were private pay @ $6/per, and most PTs started their careers in hospitals,"nursing homes", or rehabilitation centers. By the late 1960s/early 1970s, per visit fees in private P.T. offices were $45/visit. About 1971-73, the insurance companies pushed for the individual codes for billing. As a group, I can recall the P.T.s in Md. telling the companies that fees would increase immediately and significantly because we were not going to short change ourselves by devaluing our services with artificially low charges if the companies charged by codes. Of course, Blue Cross and others ignored the profession representatives and fees jumped 35% almost overnight.
    Posted by Herschel Budlow on 1/5/2013 3:29 PM
    The issue right now is that APTA needs to get the Math correct so that we all can deal with the true economic impact of this legislation. For me it is an additional 7% over and above the 6.5% last year. Most businesses that follow the Medicare rules cannot absorb the additional economic loss. The 4% that APTA claims offsets the loss is already in the calculator. Please I beseech everyone to do the math. 2013(Florida) 97110(2), 97140(1), G0283(1) = $106.51(full value) and $87.90(50%MPPR) =-17.5% 97110(2),97140(1) = $92.94(full value) and $77.79(50%MPPR) = -16.3% 97110(3) = $94.97(full value) and $79.13(50%MPPR) = -16.6% 2012(Florida) 97110(2), 97140(1), G0283(1) = 102.27(full value) and $95.42(20%MPPR) = -6.7% 97110(2), 97140(1) = $89.03(full value) and $83.49(20%MPPR) = -6.2% 97110(3) = $91.03(full value) and $85.23(20%MPPR) = -6.4% Difference between 2012 and 2013 97110(2), 97140(1), G0283(1) = +4% (full value) and -7.9%(w/MPPR) 97110(2),97140(1) = +4% (full value) and -6.8%(w/MPPR) 97110(3) = +4% (full value) and -7.2%(w/MPPR) The Grid already has the 4% increase accounted for! The true economic impact is -14% of last year’s Medicare rates. This is truly devastating to all Part B providers. Lastly the APTA grid example cites 29583(Apply multlay comprs upr arm) that pays $65.24 for one unit. It skews the numbers because the value is so high that it offsets the impact of the lesser charges. I wish PT’s used this charge but frankly it is not common (if used at all). Please tell me we are not that out of touch.
    Posted by Christopher Mulvey -> =FT]DK on 1/5/2013 4:02 PM
    My full time practice in PT is electrophysiological testing (EMG/NCV) which I am board certified and have done for the past 37 years. Medicare capriciously changed the NCV codes on 11/1/12 effective 1/1/13 with reductions of 50 to 70%. Most other insurers will most likely follow with these valuations. As this happens, I will definitely need to close down my practice since these severe payment cuts are ridiculously irrational for me to sustain a viable business. I believe and know this will be the case with other providers in similar situations which will most certainly affect patient access and quality of care.
    Posted by Michael Levrini on 1/6/2013 11:42 AM
    Christopher Mulvey: Members should use the 2012 and 2013 MPPR calculators developed by APTA to determine the impact of the MPPR 50% reduction on their particular practice; the MPPR calculator was developed for that purpose. As APTA has indicated, there is an aggregate impact of the MPPR policy on total Medicare spending on physical therapy services; however, the impact will vary for each individual practice and institutional setting depending on the individual practices billing patterns. For example, practices that typically bill 4 units per session will experience a greater reduction than those that typically bill 2 or 3 units per session. Also, practices that tend to bill CPT codes with higher practice expense values relative to the other values will experience larger percentage reductions.
    Posted by News Now Staff on 1/6/2013 7:59 PM
    Christopher Mulvey calculations look like my practice. We provide multiple services due to difficulty of patient transport in our snowy northern Michigan. I agree that the impact is understated by the APTA article.
    Posted by Ron vance on 1/7/2013 9:40 AM
    News Now Staff (in the future please identify yourself) - I used 3 units in 2 of the 3 examples above. I truly believe that it is representative of an ethical and commonly seen example of a treatment encounter. I am also well aware that the higher the number of units the greater the economic impact. But Frankly I don’t want to live in denial because we can all just see patients for 1 unit and then there would be no cuts!!! Please stop playing games with the numbers. The simple fact is that most practices will expect and additional 7% cut above the painful cuts they absorbed last year (and that includes the 4% increase that APTA touts offsets the losses). The examples that APTA uses in the grid???? CPT code 29583???? I am not the one out of touch. I look forward to the apology!
    Posted by Christopher Mulvey -> =FT]DK on 1/7/2013 1:44 PM
    If corporations didn't take advantage of it and max out everyone they treated this might not be the case!! Blame the corporations who practically force the clinicians to treat for wayyy longer than necessary!!
    Posted by d on 1/7/2013 8:30 PM
    APTA is taking the short sighted approach to Medicare payment. Our profession needs to stand back and address what the ACA is intended to achieve: better healthcare, better health for seniors, at lower cost. Our profession must move towards a life course management model for people over 64 that includes chronic health management and prevention of catastrophic and deadly, expensive events such as falls rather than episodes of care. When we do, we will be able to justify higher PT rates because our professional services have value and save Medicare costs.APTA and our profession need to embrace the intent of the ACA. PT is a solution to accessible, affordable care if we change our practice model from sickness interventions to ones that promote physical health and protect our senior adults.
    Posted by Katherine Sullivan -> ?LR[@ on 1/8/2013 9:41 AM
    d hit the nail squarely in my opinion
    Posted by Jim Villella PT on 1/8/2013 10:44 AM
    I would love to see some evidence from d. I know plenty of PTs being given "minimum" codes per visit as a mandate for employment at 1 or 2 clinic practices. What defines a corporation, d?? Is it number of clinics, hospital affiliation, etc?? We are all in the same situation, why don't we band together instead of point fingers.
    Posted by Jeff Daly on 3/19/2013 11:22 AM
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