From there, KG codes could be used, although Medicare Administrative Contractors (MACs) are attempting to limit their use to reduce the number of overpayments made as a result of improper use throughout clinics. “This frees up physical and occupational therapists to perform other important services and improve beneficiary access,” CMS noted. Really appreciate being able to complete these hours at home. On the basis of our sample results, we estimated that during the 6-month audit period, Medicare paid $367 million for outpatient physical therapy services that did not comply with Medicare requirements. Unless otherwise specified, italicized text represents quotation from CMS sources. Except as specified in paragraph (a)(3)(iii) of this section, Medicare Part B pays for outpatient physical therapy services only if they are furnished by an individual meeting the qualifications in part 484 of this chapter for a physical therapist or an appropriately supervised physical therapist assistant but only under the following conditions: Below is an outline of some of the key changes that have implications for occupational therapy practitioners in FY 2021, followed … CMS has proposed adding measures 283 and 286 (two measures of dementia) to the PT/OT specialty set). While CMS plans to increase payments for evaluation codes, payments across other codes are estimated to be reduced by 10.61%. The proposed rule for 2021 was released and included some legislative changes that are indisputable wins for PTs, OTs, and SLPs as well as some changes and payment cuts that are potentially detrimental for the entire industry. We believe that it is important to the relativity of the PFS to revalue these services to reflect the overall increase in value associated with spending time assessing and managing patients, as reflected in the changes to work values for the office/outpatient E/M visits, particularly in recognition of the value of the clinicians’ time which is spent treating a growing number of patients with greater needs and multiple medical conditions.”. Outpatient rehabilitation therapy services include physical therapy (PT), occupational therapy (OT), and speech-language pathology (SLP) services. CMS proposed to apply an RVU increase (. ) CMS was planning to have providers transition to the value pathways in 2021, however they are now planning to push back the timeline until 2022. The following summarizes the documentation requirements required under Medicare Part B. Highly recommend this course. All Therapy Services (PT,OT,SP) CMS contracts with Medicare Administrative Contractors (MACs) to process and pay Part B claims for outpatient physical therapy services provided by therapists across the United States and its territories. Physical therapist assistants and occupational therapy assistants are not precluded from serving as clinical instructors for therapy students while providing services within their scope of work and performed under the direction and supervision of a licensed physical or occupational therapist to a Medicare beneficiary. In the 2021 proposed rule, CMS acknowledged that PT, OT, and SLP evaluation services are similar to E/M codes (i.e., they both require assessment and management work) and proposed a modest payment bump for those services. Some of the highlights of the changes are: CMS announced its decision to revalue CPT codes in order to direct more payment toward evaluation and management (which includes codes therapists rarely use). It is known in physics and in science, that nothing stays the same, that everything is in a state of flux, meaning moving from one energy state to another. As per CMS: “We do not believe that the therapist-only maintenance therapy requirement is needed in the case of outpatient physical or occupational therapy services, and instead believe that it would be appropriate for an OT or PT to be permitted to use their professional judgement to assign the performance of maintenance therapy services to an OTA or PTA when it is clinically appropriate to do … The net result is a cut to Medicare reimbursement of approximately 9% starting January 2021. The pandemic in 2020 brought quick implementation and reimbursement of telehealth across the nation. “If implemented in its current form, these cuts could drive physical therapy providers out of business, particularly those who deliver care to underserved minority communities and older Americans — two populations that have already been disproportionately impacted by the public health emergency,” said Nikesh Patel, PT, executive director of the Alliance for Physical Therapy Quality and Innovation, in a statement. The Outpatient Physical Therapy/Outpatient Speech Pathology (OPT/OSP) survey is conducted in accordance with the appropriate protocols and substantive requirements in the statute and regulations to determine whether a citation of non-compliance is appropriate. 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