Monday, July 08, 2013 Proposed 2014 Physician Fee Schedule Adjusts Payment Rates, Updates PQRS, Applies Therapy Cap to CAHs Today, the Centers for Medicare and Medicaid Services (CMS) released the proposed 2014 Medicare physician fee schedule rule that updates 2014 payment amounts and revises other payment policies. Excluding the 24.4% projected sustainable growth rate payment cut, the rule’s aggregate impact on payment is a positive 1% for outpatient physical therapy services. Additional proposed policies that will impact physical therapists include updates to the Physician Quality Reporting System (PQRS) program, application of the therapy cap to critical access hospitals, and changes to the calculation of geographic practice cost indices. The law applies an annual beneficiary limit on outpatient therapy services for physical therapy and speech-language pathology services combined and a separate limit for occupational therapy services. Following the passage of the American Taxpayers Relief Act earlier this year, outpatient therapy services provided in critical access hospitals (CAHs) accrued toward the therapy cap amount for the first time. However, in 2013 CAHs are not subject to the therapy cap, meaning they currently do not have to report the KX modifier when the cap is exceeded or undergo manual medical review for services exceeding $3,700. The proposed rule would change this policy to apply the cap to outpatient therapy services furnished in CAHs in 2014 if Congress extends the therapy cap provision to hospitals in 2014. CMS proposes to retain the 12-month calendar year reporting period for the PQRS program in 2014 and beyond. The incentive payment for 2014 will remain 0.5%. The 2014 reporting period data will be used to inform both the 2014 incentive payment (0.5%) and the 2016 payment adjustment (-2.0%). CMS is proposing to make the following changes to the successful reporting requirements for 2014: Increase the number of measures that must be reported via the claims and registry-based reporting mechanisms from 3 to 9 Change the threshold for reporting individual measures via registry to require that eligible professionals report on 50% of the eligible professional’s applicable patients rather than 80% Eliminate the option to report on claims-based measures groups The proposed rule will be published in the July 19, 2013, Federal Register. The public will have until September 6, 2013, to submit comments in response to this rule, and APTA will submit comments on behalf of its members. After reviewing public comments, CMS will publish a final rule on or about November 1, which will become effective for services furnished during calendar year 2014. APTA will provide a more detailed summary of the rule in the upcoming week.