Well, we knew the cuts were coming…and the release of the “Medicare Part B” Proposed Rule rubbed it in.
CMS released the Medicare Part B Physician Fee Schedule(PFS) Proposed Rule previewing what will kick in 1/1/21. [Click to access Rule]
Let’s take a quick look at the highlights that are most pertinent to SNF therapy professionals.
Physician Fee Schedule (PFS) Proposed Rule: Medicare Part B Changes
The Proposed Rule is only 592 pages…and will be “the rule” on January 1st unless changes are made in the Final Rule coming in October. Here are the top 4 areas impacting SNF therapy professionals:
- Rates
- CMS uses a conversion factor (CF) to calculate payment rates for Part B. The CF proposed for 2021 is $32.26.
- What does this mean? Well, the CF for 2020 was $36.09, so as you can see, we are not headed in a positive direction!
- Cuts averaging 9%
- These cuts were identified for multiple CPT codes and specialties including: PT, OT, Speech/Audiology. See Table 90 below for details.
- All therapy providers will not experience the 9% cut. The % is a combined estimate for PT, OT and Speech. However, all are expected to feel some impact.
- The extent that the cuts will impact your facility depends on your practice patterns and codes you typically bill
- Why the cuts?
- These cuts are proposed to balance the adjustments made to Evaluation and Management (E/M) codes used by other specialties, primarily physicians.
- In order to keep a balanced budget, if the value of some CPT codes go up, the value of others must come down. In this case, the value of E/M codes used by physicians will increase, resulting in a decrease in the value of some “therapy codes,” as well as codes used by other specialties
- Any Good News?
- Yes! The therapy evaluation and re-evaluation codes have been “re-valued” and will see a significant increase (average of 28%).
- Codes impacted can be found on page 63 of the Rule and include:
- PT 97161, 97162, 97163; 97164
- OT 97165, 97166, 97167, 97168
- SLP 92521, 92522, 92523, 92524 […of note, the Swallowing Eval code is not included]
- Did you know you can look up any CPT code and check the rate HERE ?
- Future Cuts:
- The 15% payment reduction for services [CPT codes] provided in whole or in part by PTA’s and C/OTA’s still stands for 2022
- Continued use of the CO and CQ modifiers for services provided by assistants that meet the definition
- This article will explain all the PTA/OTA billing changes. See #4 in the article.
- Table 90 -Changes for all specialties
- CMS uses a conversion factor (CF) to calculate payment rates for Part B. The CF proposed for 2021 is $32.26.
- Virtual Services and Telehealth
- Virtual Services is the umbrella category in which Telehealth lives. Telehealth is a Virtual Service but all Virtual Services are not considered Telehealth. This is an important distinction to understand when looking at the rules. This article may help clear up any confusion.
- Virtual Services encompasses Telehealth, E-Visits, Virtual Check-Ins and Telephone E/M services.
- Only certain CPT codes can be billed in each category. See graphic below.
- Therapists were not able to provide these services prior to the Public Health Emergency (PHE) and are currently only allowed to provide certain services until the PHE ends.
- In the Proposed Rule, CMS reiterates that Telehealth is defined as remotely providing the services when not in the same location as the patient (off-site vs in another room).
- Telehealth by therapists is NOT in the Proposed Rule and will likely expire when the PHE ends…though anything is possible (See Table 12)
- Other Virtual Services may be added and will at least remain place until end of calendar year that the PHE ends
- Virtual Check-in and E-Visit will likely remain for therapists after PHE, though for Private Practice only. Codes will be G20x0, G20x2, G2061, G2062 and G2063 with appropriate therapy modifier
- Telephone E/M services are not on the list for therapists to provide after the PHE
- Graphic of current Virtual Services in place for Part B therapy during PHE
- Table 12 – Outlines Proposed Rule for Telehealth
- Direct Supervision by Interactive Telecommunications Technology
- The Proposed Rule extends the PHE rule for providing direct supervision via audio visual technology through 12/31/2021
- This does not impact the SNF setting specifically as Medicare Part A and Part B in the SNF currently require “general supervision,” meaning a therapist does not need to be in the room or on site in order for an assistant to provide services. Medicare Part B supervision rules for Private Practice, however, are more strict.
- Do not confuse this rule with your State Practice Act requirements for supervision. This is only a Medicare payment regulation, and State Practice Acts may require on-site supervision, pandemic or not.
- Provision of Maintenance Therapy by Therapy Assistants
- The Rule proposes to change the Medicare Benefit Policy Manual Chapter 15 requirement for skilled maintenance therapy which currently states must be provided by a therapist. The new rule would allow the PTA and C/OTA to provide maintenance therapy under the supervision of a therapist.
- This is currently a temporary rule under the PHE and would become permanent on 1/1/2021.
- Keep in mind, if the PHE ends prior to January 1, 2021, the therapist would need to personally furnish the maintenance therapy until 1/1/2021 when the new rule kicks in
- This article will explain all the PTA/OTA skilled maintenance criteria
So….
Change in the SNF is what we are used to. Every year. Without fail. But we’ve got this!
Remember, these changes are for Part B therapy only and will potentially carry over to Chapter 15 of the Medicare Benefit Policy Manual after January 1st.
Keep an eye out for the Final Rule next month. Once it is released, we will update you with the changes.
In the meantime, there are 2 things you can do:
- Submit comments to CMS about the Proposed Rule by 10/5/2020
- Take action and #FightTheCut. Look to APTA, AOTA and ASHA for action steps as to how you can help. APTA has developed a public page where anyone can fill out a template email and send a message to their local representatives. You can take action HERE.
As always, if you have any questions about the information or how it will impact you, send them to our Just Ask Q&A Forum. There you can also take a peek at all the other questions your peers are asking.
In Your Corner,
Dolores Montero, PT, DPT, RAC-CT, RAC-CTA
SNF Rehab and MDS Compliance Team
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