Proceed with extreme caution. Therapy changes for 2019 are coming up fast, and as a therapy provider, you must be prepared to navigate these changes prior to Jan.1, 2019.
The 2019 Medicare Physician Fee Schedule (MPFS), the Quality Payment Program (QPP) final rule, and the Bipartisan Budget Act of 2018 (which permanently eliminated the therapy cap) have all triggered continuing changes in therapy delivery, reporting and documentation for 2019.
And while, after 20 years the therapy cap was permanently repealed, the action was not without tradeoffs and it is time to pay the piper as the Centers for Medicare & Medicaid Services (CMS) has mandated the identification of services provided in whole or in part by physical therapist assistants (PTA), and occupational therapy assistants (OTA), in preparation for the mandated 15 percent reduction in payment in future years.
The therapy exceptions process was eliminated with the therapy cap, but identification of therapy over the 2019 threshold and the manual medical review threshold (MMR) is still required, as is selected review over the $3,000 threshold. Clarification of the use of the ABN for therapy services that are not medically necessary or not a Medicare benefit will be explained during the webcast led by Nancy Beckley. Medicare's Targeted Probe and Educate (TPE) has started in most MAC regions and outpatient therapy is on the list. You will benefit from a review the identified TPE topics selected by the MACs, the TPE process, the ADR process, and provide an update on various therapy findings from TPE Round #1.
PTAs and OTAs, and speech-language pathologists (SLP) are now eligible for MIPS and APM in the Quality Payment Program Year 3. Therapy providers not eligible to report will not receive a fee schedule payment increase over the next several years, and those eligible to report beginning Jan. 1, 2019 risk up to a (plus or minus) 7 percent payment adjustment for 2019 performance, for 2021 reimbursement. You will learn who is required to report, and the various reporting methods and measures available for therapy.
President Donald Trump, in 2017, signed the National Defense Authorization Act (NDAA), which included the directive to the Department of Defense to authorize PTAs and OTAs as TRICARE providers and able to provide therapy services, we will provide an update on this process, and explain why PTAs and OTAs are still prohibited from provider services to Tricare enrollees. You will also learn how to differentiate between TRICARE and Triwest.
In summary, this webcast will provide references and guidelines to assist outpatient therapy providers, regardless of venue, in understanding the applicable rules and regulations from CMS, as well as from other large commercial payers who often replicate CMS rules for therapy policy.
Why This is Relevant:
Long standing mandates have been eliminated, while additional mandates for reporting services on the claim have been added, plus there are critical changes and new updates to outpatient therapy. In addition, MACRA changes, related to decreases in reimbursement for services provided in whole or in part by PTAs and OTAs are moving forward.
Outpatient therapy payments in private practice will not be increased except for quality reporting. Facility rehab providers will not have an increase unless CMS finds a way for participating in the value reporting. Finally, the Targeted Probe and Educate (TPE) program has been focusing on therapy practices over the past several months, and the "findings" are being reported: some are surprising, some are routine.
From this webcast you will…
- Understand functional limitation as it relates to patient evaluation and reporting for 2019;
- Learn requirements for reporting and payment for PTA/OTA required under MACRA;
- Understand if you are required to report under the CMS QPP program for MIPS;
- Learn how to prepare for a CMS Targeted Probe & Educate (TPE) audit; and,
- Understand the two therapy thresholds for 2019 and what that means for patients and therapists and the use of the ABN.