On July 29, 2019, the Centers for Medicare and Medicaid Services (CMS) released the proposed rule for services paid under the Medicare Physician Fee Schedule and Other Changes to Part B Payment Policies as well as Updates to the Quality Payment Program. The latter would include the Merit-Base Incentive Payment System (MIPS). Remember that only physical therapists (PTs), occupational therapists (OTs) and speech-language pathologists (SLPs) that practice in a private practice (submit claims on a 1500-claim form to the Medicare program) are eligible to participate in MIPS. This would include a therapist owned private practice or a physician owned private

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

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

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:

UnitedHealthcare Community Plan has issued a revised coverage determination guideline for outpatient physical and occupational therapy. This policy applies to the following 12 states:

On July 15, 2019, the Centers for Medicare & Medicaid Services (CMS) released a proposal to cover acupuncture for Medicare patients with chronic low back pain (CLBP) who are enrolled participants either in clinical trials sponsored by the National Institutes of Health (NIH) or in CMS-approved studies. To read the proposed decision memo, click HERE. To submit comments on the proposed decision memo, click HERE.

Anthem Blue Cross has announced they will further delay the implementation of AIM Specialty Health and the prior authorization process for outpatient therapy services for the 13 states that were originally scheduled to begin with dates of service on and after July 1, 2019. On July 2, Anthem Blue Cross announced the implementation that began July 1, 2019 was being halted and would resume with dates of service on and after August 1, 2019. On July 16, 2019, Anthem Blue Cross announced they are

The Centers for Medicare and Medicaid Services (CMS) has issued the Home Health proposed rule for calendar year (CY) 2020. In the proposed rule, there are several proposals that could have an impact on physical, occupational and speech therapy services with one of the proposals having a potential positive impact on outpatient therapy services and another proposal recommending changes to who can provide maintenance therapy to Medicare beneficiaries who are under an active Home Health Agency (HHA) plan of care. Proposals that impact therapy services include, but are not limited to the following: