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Quality Performance Category

CMS is proposing to weigh the quality performance category at

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Cost Performance Category

CMS is proposing to weight the cost performance category at

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Improvement Activities Performance Category

CMS is proposing to increase the group or virtual group reporting threshold from at least

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Promoting Interoperability Performance Category

For the 2022 MIPS payment year, the performance period for the Promoting Interoperability performance category is a minimum of

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Complex Patient Bonus for the 2022 MIPS Payment Year

CMS is proposing to continue

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Performance Threshold

For performance year 2017, the performance threshold was 3 points. For performance year 2018, the performance threshold was 15 points. For performance year 2019, the performance threshold was 30 points. For performance year 2020 which will impact your 2022 payments, CMS is proposing a performance threshold of

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QCDRs and Qualified Registries

Beginning with performance year 2021/payment year 2023, Qualified Clinical Data Registries (QCDRs) and Qualified Registries will have to attest that they can provide performance feedback at least

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New Measures for Performance Year 2020

CMS is proposing 1 new quality measure that should be applicable to physical therapists. The name of the measure is

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PT/OT Specialty Set Quality Measures

CMS is proposing to add the following quality measures to the Physical Therapy/Occupational Therapy Specialty Set:

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CMS is proposing to delete the following quality measures from the Physical Therapy/Occupational Therapy Specialty Set:

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Speech Language Pathology Set

CMS is proposing to add the following quality measures to the Speech Language Pathology Specialty Set:

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General Measures

CMS is proposing to delete the following quality measure that was applicable to physical and/or occupational therapy

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Previously Finalized Quality Measures with Substantive Changes Proposed for the 2022 MIPS Payment Year and Future Years

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I hope you found this article to be helpful. When the final rule is released on or after November 1, 2019, watch for another article on MIPS 2020. Thank you for being a Gold Member!

 

 

 

CMS Issues IRF FY 2020 Final Rule

On July 31, 2019, the Centers for Medicare and Medicaid Services (CMS) issued the final rule for Fiscal Year (FY) 2020 for Inpatient Rehabilitation Facilities (IRFs). CMS projects that FY 2020 payments to IRF’s will increase by 2.5% compared to FY 2019. In the final rule, highlights of issues addressed by CMS include:

  • Case-Mix Group Revisions (using FY 2017 and FY 2018 data)
  • Rebase and Revise the IRF Market Basket
  • Clarification of “Rehabilitation Physician”
  • Ensuring Quality
  • IRF Quality Reporting Program (QRP)

To read a Fact Sheet of the final rule, click HERE. To access the Final Rule, click HERE.

I hope you found this article helpful.

CMS Releases Proposed Rule for Calendar Year 2020

On July 29, 2019, the Centers for Medicare and Medicaid Services (CMS) released the proposed rule for calendar year (CY) 2020 for services paid under the Medicare Physician Fee Schedule (MPFS). This proposed rule does impact providers of outpatient physical, occupational and speech therapy services in all outpatient therapy settings that does include private practices, hospital outpatient departments (including Medicare beneficiaries under Observation status and in the Emergency Department and do not get admitted to the hospital), skilled nursing facilities, rehabilitation agencies, comprehensive outpatient rehabilitation facilities and home health agencies providing outpatient therapy in a Medicare beneficiaries home.

Highlights of the proposed rule include:

  • Proposing to revise the regulations at §§ 410.59 and 410.60 discussing the annual therapy threshold, use of the KX modifier, and the targeted medical review threshold
  • CQ/CO Modifiers to be appended to CPT codes for services provided in whole or in part by a PTA or OTA
  • To add a requirement that the treatment notes explain, via a short phrase or statement, the application or non-application of the CQ/CO modifier for each service furnished that day
  • PTA and OTA Payment Changes in 2022
  • New CPT codes for trigger point dry needling
  • New Biofeedback CPT codes
  • New Health and Behavioral Assessment and Intervention CPT codes
  • Discussing the 2 new Cognitive Function Intervention CPT codes
  • Work relative value unit (RVU) for CPT codes 97597 and 97598
  • Proposing an Active Status for CPT codes 97607 and 97608
  • Proposing a work RVU of 0.40 for CPT code 97610
  • Online Digital Evaluation Service HCPCS Level II Codes
  • 2020 Medicare Physician Fee Schedule Conversion Factor
  • 2020 MIPS Program

Revising Regulations at §§ 410.59 and 410.60

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CQ and CO Modifiers

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de minimis Standard for CQ and CO Modifiers

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Documentation Requirements to Support Use of or Non-use of CQ/CO Modifiers

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PTA and OTA Payment Changes in 2022

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New CPT Codes for Trigger Point Dry Needling

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Biofeedback CPT codes

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New Health and Behavioral Assessment and Intervention CPT Codes

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Cognitive Function Intervention CPT Codes

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CPT Codes 97597 and 97598

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CPT Codes 97607 and 97608

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CPT Code 97610

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Online Digital Evaluation Service

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When you see the letter “X” in a new CPT code, this “X” will be replaced by the actual number that is in the CPT code once the American Medical Association (AMA) releases the 2020 CPT codes in early September. The same is true with the letters “NPP” in the 3 new HCPCS codes described above. These letters will be replaced by numbers once the AMA releases the 2020 CPT codes in early September.

2020 Medicare Physician Fee Schedule Conversion Factor

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MIPS 2020

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I hope you found this article informative. To access the proposed rule, click

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UnitedHealthcare Community Plan Implements Prior Authorization for Therapy

UnitedHealthcare Community Plan has announced they will implement prior authorization for outpatient physical, occupational and speech therapy services in select states beginning as early with dates of service on and after August 1, 2019. In addition, UnitedHealthcare Community Plan has announced they will be conducting site of service medical necessity reviews for all speech, occupational and physical therapy services in select states.

Effective with dates of service on and after August 1, 2019, the following states will be required to obtain prior authorization before implementing outpatient physical, occupational and/or speech therapy services:

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