If you are on social media, whether Facebook, LinkedIn, X (formerly Twitter), I am sure you are seeing posts of therapists in private practices complaining about the difference in reimbursement hospital outpatient therapy departments receive compared to a private practice when providing the exact same intervention(s) and/or procedure(s). However, instead of complaining, I think private practices should use this discrepancy to their advantage. In this article, I will answer the following questions and provide valuable insight how private practices can use this discrepancy to increase their business and revenue.

Many employees of hospitals do not understand how the Centers for Medicare and Medicaid Services (CMS) reimburse for outpatient physical, occupational, and speech therapy services provided by a hospital outpatient therapy department. Does CMS reimburse for these services under the Medicare Physician Fee Schedule (MPFS) or the Outpatient Prospective Payment System (OPPS)? In this article, I will answer the following questions:

On August 4, 2020, the Centers for Medicare and Medicaid Services (CMS) released the calendar year (CY) 2021 proposed rule titled “Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs; New Categories for Hospital Outpatient Department Prior Authorization Process; Clinical Laboratory Fee Schedule: Laboratory Date of Service Policy; Overall Hospital Quality Star Rating Methodology; and Physician-owned Hospitals.“ Highlights of the proposed rule include: CMS is proposing to eliminate the Inpatient Only (IPO) list over a three-year transitional period with the list completely phased out by CY 2024 CMS is proposing to expand the

The Centers for Medicare and Medicaid Services (CMS) has published a revised edition of MLN Matters Number: MM11814 on July 16, 2020 that provides an update of the Hospital Outpatient Prospective Payment System (OPPS). This update contains information on the Telephone Services CPT codes (98966 – 98968) as well as the virtual check-in and E-Visit Level II HCPCS Codes (G2010, G2012, and G2061-G2063). Click HERE to access MM11814.