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  • CMS Proposed 2015 Fee Schedule Adjusts Payment Rates, Updates PQRS

    The proposed 2015 Medicare physician fee schedule (PFS) rule released July 3 would result in an estimated 20.9% reduction in payments beginning April 1, 2015, unless congressional action is taken to avert sustainable growth rate (SGR) reductions. If those reductions are avoided, the rule’s aggregate impact on payment is a positive 1% for outpatient physical therapy services. Either way, the first quarter of 2015 would see no change in payment rate due to the Protecting Access to Medicare Act (PAMA) of 2014, provides for 0% PFS update for services furnished between January 1, 2015 and March 31, 2015.

    Additional proposed policies that will impact physical therapists include updates to the Physician Quality Reporting System (PQRS) program, CMS’s proposal to review the values that determine payment for a number of CPT codes reported by physical therapists, and a proposal for a new process for establishing PFS payment rates that is more transparent.

    • CMS proposes to retain the 12-month calendar year reporting period for the PQRS program in 2015 and beyond. The 2015 reporting period data will be used to inform the 2017 payment adjustment of -2.0%. CMS is proposing to make the following changes to the reporting requirements for 2015:
    • Increase the number of measures that an eligible professional must report via the claims and registry-based reporting mechanisms to at least 9 measures, covering at least 3 of the NQS domains, or, if fewer than 9 measures apply to the eligible professional, he or she must report as many as do apply and report each measure for at least 50% of the Medicare Part B fee for service. Of the measures reported, some must be included from the new crosscutting measure set.
    • Make 2015 PQRS data available in 2016 on the Physician Compare website for all providers participating as eligible professionals and for those reporting under the Group Practice Reporting Option (GPRO).
    • Change measures reported by physical therapists for the remainder of 2014 , including the removal of measure #245 Use of Wound Surface Culture Technique in Patients with Chronic Skin Ulcers and the Back Pain Measures Group (#148-#151).

    The proposed rule will be published in the July 11, 2014, Federal Register. The public will have until September 2, 2014, 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 2015. APTA will provide a more detailed summary of the rule in the upcoming week.


    • Once again, the policy makers, who may have good intent, are ignoring the fiscal realities of what it costs us to comply with their regulations, let a lone pay for the costs of providing services.

      Posted by Caroline Taylor on 7/4/2014 6:49 PM

    • Certifcation dates, functional G-codes, 8-minute rule, Arbitrary caps with KX modifiers and reviews, bundling with speech therapy, and now 9 PQRS measures...CMS is out of control and out of touch with the time (and cost) it takes to properly administer and record this data. Where will it end?

      Posted by Chris Z. on 7/5/2014 4:52 PM

    • Chris Z.--Don't forget No Double Booking/overlap (unless your bill group), having to add 59 modifier for silly reasons, and MPPR.

      Posted by Jason Hazelett on 7/5/2014 10:53 PM

    • those who make the laws especially this one and those previous are ignorant to the realities of patientcare.they assume that all care is bogus;however, if their loved ones needed it they would want the best available.to get the best of anything you have to pay for it and with this crap continuing only the worst will come.if you average the rate we get per hour for quality care we get less then a plumber-electrician. eventually with this continuning NO ONE will want to take medicare just as we are stopping to accept workmans compensation patients. Good luck to those brilliant scholars that write this stuff.

      Posted by harry m.brafmann.P.T. on 7/6/2014 10:23 PM

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