Latest News says that if Healthcare Reform is going to pass it would be in the fashion of the Senate's Bill. Experts say that this is the best chance for a bill to pass.
Mental Health Providers would benefit from increases to client eligibility qualifications to Medicaid and Medicare programs. This would also correct the 21.9% decrease to providers fees.
Therapy and Rehab Providers would benefit in the same avoiding fee reductions. In addition the Therapy Cap Exception Process would be reinstated.
Thursday, January 21, 2010
Monday, January 4, 2010
Temporary Update to the Therapy Cap Extension Status
Information from APTA efforts to defend an perseve the Therapy Cap Exception Process
On December 22, President Obama signed the Department of Defense Appropriations Act of 2010, which temporarily suspends for 2 months the 21.9% Medicare physician fee schedule payment cut that was to be implemented on January 1, 2010. This will hold the conversion factor at 2009 levels through February 28, 2010, to enable physicians, physical therapists, and other health care providers to continue to care for Medicare patients while waiting for Congress to vote on a permanent solution.
The Department of Defense Appropriations Act did not include language to extend the therapy cap exceptions process or rural payment floor updates. APTA worked aggressively to add an extension of the therapy cap exceptions process to this bill but was unsuccessful. In suspending the fee schedule cuts until February 28, members of Congress believed that individuals would not hit the therapy cap in 2 months, and as a result did not extend the exceptions process. APTA disagrees with Congress’s reasoning.
On January 1, a $1,860 per year/per beneficiary cap for outpatient physical therapy and speech language pathology services combined, and an $1,860 cap for outpatient occupational therapy services (hospital outpatient departments are exempt), will go into effect -- without an exceptions process. The KX modifier used to signify care that is medically necessary when the therapy cap amount is exceeded will no longer be applicable.
In addition, a 1.0 minimum floor on the work Geographic Practice Cost Index (GPCI) values that were established by Congress will expire on January 1, 2010. The expiration of this floor will result in reductions in payments in 2010 for 54 localities.
The Senate’s and House of Representatives’ comprehensive health care reform proposals -- the Patient Protection and Affordable Care Act (HR 3590) and the American's Affordable Health Choices Act (HR 3962) -- contain provisions to extend the therapy cap exceptions process and update the rural payments. On December 24, the Senate passed HR 3590. However, the bill now must be merged with the House’s reform bill. It is unlikely that negotiations on a final health care bill will begin before January 5, 2010. To view a summary of HR 3590 and HR 3962, please visit APTA’s Health Care Reform Resource Center.
APTA will continue to work vigorously in the new year and throughout the House and Senate conference process to ensure that the final bill positively addresses key issues for physical therapy, such as the therapy cap and the fee schedule payment cuts, to preserve patients’ access to needed physical therapy services.
On December 22, President Obama signed the Department of Defense Appropriations Act of 2010, which temporarily suspends for 2 months the 21.9% Medicare physician fee schedule payment cut that was to be implemented on January 1, 2010. This will hold the conversion factor at 2009 levels through February 28, 2010, to enable physicians, physical therapists, and other health care providers to continue to care for Medicare patients while waiting for Congress to vote on a permanent solution.
The Department of Defense Appropriations Act did not include language to extend the therapy cap exceptions process or rural payment floor updates. APTA worked aggressively to add an extension of the therapy cap exceptions process to this bill but was unsuccessful. In suspending the fee schedule cuts until February 28, members of Congress believed that individuals would not hit the therapy cap in 2 months, and as a result did not extend the exceptions process. APTA disagrees with Congress’s reasoning.
On January 1, a $1,860 per year/per beneficiary cap for outpatient physical therapy and speech language pathology services combined, and an $1,860 cap for outpatient occupational therapy services (hospital outpatient departments are exempt), will go into effect -- without an exceptions process. The KX modifier used to signify care that is medically necessary when the therapy cap amount is exceeded will no longer be applicable.
In addition, a 1.0 minimum floor on the work Geographic Practice Cost Index (GPCI) values that were established by Congress will expire on January 1, 2010. The expiration of this floor will result in reductions in payments in 2010 for 54 localities.
The Senate’s and House of Representatives’ comprehensive health care reform proposals -- the Patient Protection and Affordable Care Act (HR 3590) and the American's Affordable Health Choices Act (HR 3962) -- contain provisions to extend the therapy cap exceptions process and update the rural payments. On December 24, the Senate passed HR 3590. However, the bill now must be merged with the House’s reform bill. It is unlikely that negotiations on a final health care bill will begin before January 5, 2010. To view a summary of HR 3590 and HR 3962, please visit APTA’s Health Care Reform Resource Center.
APTA will continue to work vigorously in the new year and throughout the House and Senate conference process to ensure that the final bill positively addresses key issues for physical therapy, such as the therapy cap and the fee schedule payment cuts, to preserve patients’ access to needed physical therapy services.
Friday, January 1, 2010
2010 CPT Changes- Consultation Codes- Medicare
Get ready for changes to Medicare's reimbursement for consultation codes, beginning January 1, 2010. Medicare will no longer recognized consultation codes for payment. Confusion begins with the fact that the 2010 CPT, Current Procedural Terminology, Copyright held by AMA, American Medical Association, All rights reserved, continue to list under the "Evaluation and Management" section, consultation codes (99241-99245) and (99251-99255). To add to the confusion it is unclear as to how private insurance carriers and third party payers will respond to this change.
This change will effect both outpatient and inpatient consultations. Over payments reported in 2001 by Office of Inspector General Report, states that Medicare payed out approximatley $1.1 billion in overpayment. to providers. It is estimated that 75% of services were reported as improperly documented consultation services.
Billing Solutions beginning January 1, 2010:
If provider would have billed an inpatient consultation (99251-99255) now effective January 1, 2010 to Medicare, that provider should report this services under initial inpatient visit codes (99221-99223). For this to work well, meaning every physician gets paid, the admitting physician needs to append a modifier (Al) subject to change by carrier.
For outpatient settings: Medicare will pay for, new patient visit codes (99201-99205) patients qualify as a new patient if the patient wasn't seen by provider within speciality within the past three years. Medicare will also pay for established patients (99211-99215).
Author: Sherry Marchand-CPMA (Certified Professional Medical Auditor), National Seminar Speaker, Topics included Coding and Billing for Mental Health Services, Coding and Billing Therapy and Rehab, Reimbursement Specialist, Certified Practice Management Consultant. 2O years experience in Coding, Billing and Compliance.
This change will effect both outpatient and inpatient consultations. Over payments reported in 2001 by Office of Inspector General Report, states that Medicare payed out approximatley $1.1 billion in overpayment. to providers. It is estimated that 75% of services were reported as improperly documented consultation services.
Billing Solutions beginning January 1, 2010:
If provider would have billed an inpatient consultation (99251-99255) now effective January 1, 2010 to Medicare, that provider should report this services under initial inpatient visit codes (99221-99223). For this to work well, meaning every physician gets paid, the admitting physician needs to append a modifier (Al) subject to change by carrier.
For outpatient settings: Medicare will pay for, new patient visit codes (99201-99205) patients qualify as a new patient if the patient wasn't seen by provider within speciality within the past three years. Medicare will also pay for established patients (99211-99215).
Author: Sherry Marchand-CPMA (Certified Professional Medical Auditor), National Seminar Speaker, Topics included Coding and Billing for Mental Health Services, Coding and Billing Therapy and Rehab, Reimbursement Specialist, Certified Practice Management Consultant. 2O years experience in Coding, Billing and Compliance.
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