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  • Today's Need-to-Know: 2014 Medicare Payment Changes

    Before adjourning for the holidays, Congress passed the Pathway for SGR Reform Act of 2013, temporarily preventing a scheduled physician fee schedule payment cut from taking effect on January 1, 2014, and extending the therapy cap exceptions process. The temporary patch expires March 31, 2014, giving the House and Senate until then to finalize legislation that would permanently repeal the flawed sustained growth rate (SGR) formula that has vexed physical therapists, physicians, and other health care professionals since it was enacted in 1997.

    Other changes included in the 2014 Medicare physician fee schedule final rule also affect physical therapist practice and payment for 2014. Below is a summary of the changes and their timelines.

    Effective January 1–March 31, 2014:

    • A 0.5% update in the conversion factor for providers, making the 2014 conversion factor for these 3 months $35.8228
    • An extension of the existing 1.0 geographic practice cost index (GPCI) work floor
    • An extension of the therapy cap exceptions process at $1,920 annually for all outpatient settings
    • An extension of the manual medical review process for therapy services that exceed $3,700 annually for all outpatient settings

    Effective January 1–December 31, 2014:

    • Application of the therapy cap in critical access hospitals for 2014, in the same manner as all other providers of outpatient therapy services
    • To avoid the year 2016 2.0% payment penalty under the PQRS program, a requirement for physical therapists in private practice to report at least 3 individual measures via either claims or registry; or, to receive a 0.5% bonus payment in 2014 as well as avoid the 2016 penalty, a requirement to report 9 measures or, if 9 measures are not applicable, to report the number that apply

    APTA will provide member resources and update its fee schedule calculator in the coming days on its 2014 Changes Webpage. This page includes summaries of the 2014 final rules, a 2014 FAQ on Medicare changes, and summaries of the House and Senate SGR reform proposals being worked on when Congress returns from the holiday recess.

    The Senate is expected to return on January 6 and the House on January 7. Congress will resume negotiations on the proposals and begin discussing how to pay for the cost of the SGR reform legislation.

    APTA will continue to work with members of Congress to ensure the final reform package includes policies that reflect the interests of physical therapists and the patients we serve. Members interested in joining APTA's advocacy efforts to reform SGR and repeal the therapy cap can sign up for PTeam.


    • What are the individual measures? Are these functional testing scores?

      Posted by Judith Verbanets -> BLV_@L on 1/3/2014 5:05 PM

    • Hi Judith I use DASH for Upper Extremity, LEFS for Lower Extremity and back and neck index for those body parts respectively. These are questionaires which your patients need to fill out prior to eval and then again every 10 visits to calculate their % functional disability. this is how we calculate G-codes. if you look at my website you can print them off directly under the "new patient" tab. I also use 3-4 ROM, Strength, or other objective measures every single visit to track progress. Happy Medicare = New Year!

      Posted by CF DPT OCS on 1/5/2014 7:03 PM

    • Judith, the individual measures are the PQRS codes, they are numbered and found at the AMA PQRS website located in the APTA website. The reporting mechanism is dependant on how bills are submitted,individual vrs registry. They include areas such as Pain Index, Falls prevention, medication list and (chiro)functional outcomes. The AMA provides a paper trail with check-list format and associated requirements/correct code numbers as well as work sheets.

      Posted by Erick Jackowsky on 1/7/2014 8:01 AM

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