On December 1, 2020, the Centers for Medicare and Medicaid Services (CMS) released the final rule for services paid under the Medicare Physician Fee Schedule (MPFS). This would include outpatient physical, occupational and speech therapy services provided in all outpatient therapy settings except for a critical access hospital. Highlights of the final rule include, but are not limited to, the following: 2021 Medicare Conversion Factor and 9% Payment Reduction Accessing the 2021 Relative Value Units (RVU’s) for Each CPT Code 2021 Annual Therapy Threshold Dollar Amount Student Documentation in the Medical Record Maintenance Therapy Provided by PTA’s and OTA’s Communication-Based

On August 4, 2020, the Centers for Medicare and Medicaid Services (CMS) released the fiscal year (FY) 2021 Final Rule for Inpatient Rehabilitation Facilities (IRFs). Highlights of the final rule include: Permanent elimination of the post-admission physician evaluation effective October 1, 2020 CMS is finalizing that a non-physician practitioner (NPP) may perform one of the three required visits in lieu of the physician in the second and later weeks of a patient’s care, when consistent with the NPP’s state scope of practice Overall IRF payment update for FY 2021 of 2.8% To access the Final Rule, click HERE. To access

On July 31, 2020, the Centers for Medicare and Medicaid Services (CMS) released the Skilled Nursing Facility (SNF) Fiscal Year (FY) 2021 final rule titled “Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities; Updates to the Value-Based Purchasing Program for Federal Fiscal Year 2021“. Highlights of the final rule include the following: CMS projects that aggregate Medicare program payments to SNFs will increase by $750 million, or 2.2 percent, for FY 2021 compared to FY 2020. Changes to the ICD-10 code mappings, effective October 1, 2020 to classify SNF patients into payment groups. CMS is finalizing

On November 1, 2019, the Centers for Medicare and Medicaid Services (CMS) released the final rule for services paid under the Medicare Physician Fee Schedule (MPFS) and the Merit-Based Incentive Payment System (MIPS) program for calendar year (CY) 2020. Highlights of the final rule include, but are not limited to, the following: 2020 Medicare Conversion Factor 2020 Annual Therapy Threshold Dollar Amount Dry Needling CPT Codes CO/CQ Documentation Requirements New PTA and OTA Modifiers Effective January 1, 2020 Discipline Specific Therapy Modifiers (GO and GN) Biofeedback CPT Codes Cognitive Function Interventions Negative Pressure Wound Therapy Here we go! 2020 Conversion

On October 31, 2019, the Centers for Medicare and Medicaid Services (CMS) issued the final rule for Home Health Agencies for calendar year 2020. Highlights of the final rule include: CMS projects that aggregate Medicare payments to HHAs in CY 2020 will increase by 1.3 percent, or $250 million CMS will allow physical therapist assistants and occupational therapy assistants to provide maintenance therapy Home health episode of care will decrease for a 60-day episode to a 30-day episode Beginning in 2021, CMS will require HHAs to submit a notification to CMS within 5 calendar days from the start of care

The Centers for Medicare and Medicaid Services (CMS) has released the Fiscal Year 2020 final rule for the Prospective Payment System (PPS) and Consolidated Billing for Skilled Nursing Facilities (SNF). This final rule finalizes the new payment system, Patient Driven Payment Model (PDPM), that goes into effect with dates of service on and after October 1, 2019. In addition, the final rule revises the definition of group therapy under the SNF PPS and updates requirements for the SNF Quality Reporting Program (QRP) and the SNF Value-Based Purchasing (VBP) Program. To access the final rule, click HERE. In addition, Gawenda Seminars

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