The Centers for Medicare and Medicaid Services has informed the American Physical Therapy Association and the American Hospital Association that critical access hospitals (CAHs) will not be under the therapy cap. However, therapy furnished in the outpatient department of a CAH will be applied to the therapy cap dollar threshold for all other outpatient therapy settings.

Effective Jan. 1, 2011, the Centers for Medicare and Medicaid Services (CMS) initiated a new multiple procedure payment reduction policy to reduce the practice expense portion of certain physical, occupational and speech/language therapy procedures by 20 percent in the priavte practice setting, when these procedures are the secondary and/or subsequent procedures reported on a single date of service for the same patient. The policy applies to procedures identified with a Multiple Procedure (MP) indicator 5 on the CMS National Physician Fee Schedule. UnitedHealthcare Medicare Solutions will align with CMS and implement the new Multiple Therapy Reduction Policy, effective with claims

The Office of the Inspector General (OIG) released their fiscal year (FY) 2013 work plan that summarizes new and ongoing reviews and activities that OIG plans to pursue with respect to Health and Human Services programs and operations during the next FY and beyond. Pages of interest to the therapy profession would include pages 8, 20, and 55. To access the work plan, click

The Medicare Payment Advisory Commission (MedPAC) held a 2-day meeting on November 1-2, 2012. In the meeting, one of the topic discussed was improving Medicare’s payment system for outpatient therapy services. To prepare for the presentaiton, MedPAC prepared a brief and preentation for the meeting. MedPAC discussed the number of beneficiaries that received outpatient therapy servcies in 2011, the cost to the Medicare program for those outpatient therapy services, what setting those services occurred in by percentage (i.e. private practice, SNF, rehab agency, outpatient hospital, etc.), where the top 10% and lowest 10% of spedning occurred, and percentage of Medicare

The multiple procedure payment reduction (MPPR) policy is scheduled to increase to 50% on April 1, 2013. APTA estimates the application of a 50% MPPR policy will reduce payments by approximately 6-7% in aggregate for outpatient therapy services. This reduction will be partially offset by a 4% increase in practice expense that resulted from the Centers for Medicare and Medicaid Services’ use of new survey data of practice expenses conducted by APTA. The impact of the MPPR reduction on individual practices and facilities will vary depending on the CPT codes billed and the typical duration of the therapy sessions. For

On January 1, 2013, the House and Senate passed the “American Taxpayer Relief Act of 2012″. This bill has several important provisions for outpatient therapy services. Here is a summary of the bill…

Any therapy pre-approval requests received on or after December 17, 2012 will not be approved or disapproved. Claims associated with these requests will be subject to prepayment or post payment review. This is necessary and appropriate to allow 10 business days to approve requests. Requests received on or after December 17, 2012 would otherwise extend past December 31, 2012 (where there are no exception requests since a new cap starts on January 1, 2013).

On December 21, the Centers for Medicare & Medicaid Services revised several transmittals related to the claims-based data collection requirements for outpatient therapy. To access the transmittals, click on the appropriate link below.