Physical therapy services represent a significant portion of Medicare expenditures in postacute care settings—services provided in inpatient rehabilitation facilities (IRFs), long-term care hospitals (LTCHs), skilled nursing facilities (SNFs), and via home health agencies (HHAs) under Medicare Part A. PTs practicing in postacute care are integral to improving the quality of care provided to patients while reducing overall costs. This is particularly true under new value-based payment initiatives such as bundled payment models, accountable care organizations, and patient-centered medical homes.
APTA supports health care payment reforms in postacute care when they ensure access to physical therapy services that focus on the unique needs of patients. However, changes being made to the payment systems for IRFs, SNFs, LTCHs, and HHAs could have a drastic impact on the profession. The resources on this page will help you prepare for the postacute care reforms that are being implemented now and over the next several years.
Combined Postacute Care Reform Information
This Medicare Postacute Care Reform webpage hosts resources and updates on payment reform efforts that affect all postacute care settings—IRF, SNF, LTCH, and HHA. This reflects Medicare's desired move toward a unified payment system that eventually would replace the existing 4 individual systems. On the individual APTA webpages for each setting under Medicare Coding & Billing, you'll continue to find links to APTA comments and fact sheets specific to the regulations that govern those settings, which can be accessed by clicking on the appropriate link below:
How to Learn More:
Ongoing IMPACT Act Implementation
On September 18, 2014, Congress passed the Improving Medicare Postacute Care Transformation Act of 2014 (IMPACT Act). The Act requires the submission of standardized data by LTCHs, SNFs, IRFs, and HHAs. Additionally, the Act requires the development and reporting of measures pertaining to resource use, hospitalization, and discharge to the community. Through the use of standardized quality measures and standardized data, the intent of the Act, among other obligations, is to enable interoperability and access to longitudinal information for such providers to facilitate coordinated care, improved outcomes, and overall quality comparisons.
In implementing the IMPACT Act, CMS established quality-reporting programs for HHAs, IRFs, LTCHs, and SNFs. Additional information about the IMPACT Act and each setting-specific quality-reporting program can be found below.
Information on New Payment Methodologies for SNFs and Home Health Agencies
CMS is implementing significant changes that will affect payment for SNFs beginning in FY 2019 and for home health services beginning in CY 2020. Included are the new Patient-Driven Payment Model (PDPM) in skilled nursing facilities and the Patient-Driven Groupings Model (PGPM) in home health. APTA's webpage of resources on these models includes a recorded "myth-busting" webinar on the PDPM and PDGM, and background on both models with links to further information and explanation.
Documentation and Billing: What You Need to Know
Review information on coding and billing on APTA's Coding and Billing webpage.
Review the list of ICD-10-CM codes to be used for discharges and patient encounters occurring from October 1, 2018, through September 30, 2019. (Discharge is the point at which the patient leaves the setting and either returns home or is transferred to another facility. The term "encounter" is used for all settings, including hospital admissions, and describes an interaction between a patient and health care provider (ie, a visit).
Postacute PPS Assessments Guidance Manuals
Postacute PPS assessment manuals provide guidance for facilities and agencies on collecting accurate data through the assessment tool. These tools include both general data-collection conventions and item-specific guidance, as well as links to quality-related resources for agencies and facilities.