Automatic annual increases in Medicare payment for outpatient therapy services is coming to an end after 2019 unless you participate successfully in the Merit-Based Incentive Payment Program (MIPS). Due to the passage of the Medicare Access and Chip Reauthorization Act of 2015, providers of outpatient therapy services received an annual update of 0.5% from July 2015 through 2019. For calendar years 2020-2025, there will be no update to the conversion factor that CMS uses to determine the payment amount for each CPT code paid under the Medicare Physician Fee Schedule. For 2026 and beyond, providers who participate in alternative payment models will have an annual update of 0.75% and all others will have an annual update of 0.25%.
Now for the bad news. Only physical therapists (PTs) and occupational therapists (OTs) in private practice (submit claims on a 1500 claim form) are eligible to participate in MIPS beginning in 2019 according to the proposed rule released by CMS on July 12, 2018. In 2019, if PTs and OTs are successful in MIPS reporting, they can be eligible for a positive payment adjustment up to 7% in calendar year 2021. In 2020, if PTs and OTs are successful in MIPS reporting, they can be eligible for a positive payment adjustment up to 9% in calendar year 2022.
Unfortunately, non-private practices (submit claims on a UB-04 claim form) are not eligible to participate in the MIPS program. This means as of the writing of this article, non-private practices will see no increases in their Medicare payment from 2020 through 2025.
I will be providing a webinar on September 26, 2018 to assist PTs and OTs in their preparation to get ready for MIPS in 2019. This webinar will assist physical therapists and occupational therapists in private practices, office managers, administrators and owners of private practices, and billers and billing companies of private practices in their preparation for possibly being MIPS eligible in calendar year 2019. This webinar will teach participants the 4 categories of MIPS and what is included within each category, how each category is weighted that then determines your final score, different ways to participate in MIPS, payment adjustments based on your score, low-volume thresholds that may give private practices the opportunity to not be required to participate in MIPS and the low-volume opt-in option.
At the conclusion of this webinar presentation, participants will be able to:
- List the 4 categories in the 2019 MIPS program and how each category is weighted
- Recite how MIPS eligible clinicians can report the data to CMS
- Explain the 2-phase Determination Period and how it will determine if you must participate in MIPS to avoid a negative payment adjustment
- Differentiate the 3 options available to participate in MIPS
- List the 3 low-volume thresholds that would exclude a MIPS eligible clinician from being required to participate in MIPS
- Explain the low-volume opt-in option available to physical and occupational therapists in private practice
For additional information on this webinar and to register, click HERE.
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