Major Medicare Policy Changes Take Effect Today –

Is Your Practice in Compliance?

 

Despite aggressive advocacy efforts by the American Physical Therapy Association and a broad coalition of health provider groups, the US Congress adjourned last week without completing action on legislation preventing a 10.6% cut in the Medicare fee schedule conversion factor and extending the therapy cap exceptions process. As a result, physical therapists need to be prepared for the implementation of several significant Medicare payment policies – effective today, July 1.

 

The Centers for Medicare and Medicaid Services (CMS) has announced that it will hold claims for services provided on or after July 1 for 10 business days to provide more time for Congress to pass legislation preventing the 10.6% fee schedule cut. However, if corrective legislation is not enacted into law by July 15, CMS will begin processing those claims with the payment reduction applied – so the 10.6% reduction is effective today, as required by current law – until Congress and the Administration complete action to change it.

 

APTA continues to work with members of Congress and the Administration to secure enactment of legislation when Congress reconvenes July 7 to prevent cuts in Medicare payment and restore the therapy cap exceptions process. 

 

The following Medicare policy changes that impact physical therapists practice take effect today – physical therapists should take steps immediately to assure compliance with these policies:

 

o       A 10.6% reduction in the Medicare physician fee schedule conversion factor

Due to the flawed "sustainable growth rate" formula in current law, payments under the Medicare physician fee schedule will be reduced by an average of 10.6% for all providers - with substantially deeper cuts in some geographic areas and for specific provider groups.

 

o       Expiration of the 1.0 floor on the geographic practice cost index

The elimination of the floor that prevents reductions in the geographic practice cost index will further reduce Medicare physician fee schedule payments in 54 localities around the country in addition to the conversion factor reduction.

 

o       Expiration of the Medicare therapy cap exceptions process

The process for patients to qualify for Medicare coverage of services exceeding the 2008 therapy cap of $1,810 will cease to exist – and therapy services provided since January 1, 2008, will count toward the annual financial cap even if they were provided under an exception. The KX modifier should no longer be used on claims beginning July 1.

 

o       Implementation of competitive bidding for durable medical equipment and prosthetic and orthotic services (DMEPOS) in 10 metropolitan statistical areas

Medicare beneficiaries in 10 designated sites will be required to obtain wheelchairs, walkers, and other DMEPOS items from suppliers who bid at or below competitive rates, which may result in physical therapists in those areas having to obtain these items from different suppliers.

 

o       Revision of personnel qualifications for physical therapists and physical therapist assistants in Medicare Part A settings

Skilled nursing facilities and hospitals will be required to ensure that physical therapists and physical therapist assistants who provide services to Medicare beneficiaries meet the recently revised qualifications (42 CFR Section 484.4).

 

o       Implementation of new Medicare enrollment applications

Physical therapists enrolling for the first time as providers in the Medicare program or updating their enrollment information must use the newly revised 855 enrollment forms.

 

A complete summary of these policy changes and extensive resources is available on the APTA Web site to assist Association members in understanding and complying with these policies.

 

Please refer to the APTA Web site for the latest updates – and please continue to contact your members of Congress through the APTA Legislative Action Center to urge immediate action on Medicare legislation when Congress reconvenes. Your patients can also tell Congress about the impact of these policies on their health care by using the Patient Action Center on the APTA Consumer Web site.