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01/03/22

Medicare Payment Amounts for 2022 – Examples

On November 2, 2021, the Centers for Medicare and Medicaid Services (CMS) released the calendar year (CY) 2022 Final Rule for services reimbursed under the Medicare Physician Fee Schedule (MPFS). This rule does apply to outpatient physical, occupational and speech therapy services provided in all outpatient therapy settings except a critical access hospital (CAH) since a CAH is not reimbursed under the MPFS. This proposed rule only applies to traditional Medicare and not Medicare Advantage plans. In the final rule, CMS stated the 2022 Conversion Factor (CF) would be 33.5983. This would be a 3.75% decrease compared to the 2021

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12/21/20

MIPS 2019 Results: Questions and Answers

If you are a physical therapist, occupational therapist or speech-language pathologist in private practice and you participated in the 2019 Merit-Based Incentive Program (MIPS), you have now received your MIPS score and payment adjustment percentage for calendar year 2021. In this article, I will answer several questions that I have been receiving to help you understand what will be occurring in 2021. QuestionIs it possible for a therapist who has their own individual NPI number, is employed or contracted by multiple private practices (different TINs) and submitted claims to Medicare under each NPI/TIN combination to have different MIPS scores for

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09/08/20

Stop the 9% Outpatient Therapy Cut

The proposed Medicare Physician Fee Schedule for 2021 is calling for an estimated 9% decrease in payment for codes tied to Part B physical, occupational and speech therapy services. I am asking you to contact your representative in the House of Representatives and your 2 United State Senators to prevent these cuts, which will reduce patient access and create instability in the health care system. Contact your Members of Congress today. Please do this in addition to submitting comments to CMS that I discuss below. WE NEED BOTH! In addition and equally important is communicating your opposition to the Centers for Medicare and Medicaid

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08/24/20

How Does CMS Determine the Payment of a CPT Code

Two questions I am often asked is how does the Centers for Medicare and Medicaid (CMS) determine the payment for each CPT code and why is the same CPT code paid differently depending on where the practice or facility is located? In this article, I will answer how CMS determines the payment for each CPT code and why the same CPT code reimburses differently based on the location of your practice or organization. QuestionHow does CMS determine the payment for each CPT code? Answer QuestionWhat is included in the work relative value unit (RVU) of a CPT code? Answer QuestionWhat

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02/07/19

Collecting Medicare Deductibles & Coinsurance at Time of Service

With the start of each new year, the question of can I collect the deductible and/or coinsurance from a Medicare beneficiary at the time of service or must I submit the claim to my Medicare Administrative Contractor first and wait for the explanation of benefits (EOB) to see what the financial responsibility is to the Medicare beneficiary? Well, the Centers for Medicare and Medicaid Services (CMS) does answer this question. In CMS Publication

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