|To our valued customers:|
Without legislative action by the end of 2020, skilled nursing providers were facing significant cuts to Medicare reimbursement in 2021. Therapy services covered under Medicare Part B were set to be reduced by 9%. In addition, the Medicare sequestration of 2% was set to resume on January 1, 2021.
WHAT YOU NEED TO KNOW
On December 21st, Congress passed the Consolidated Appropriations Act of 2021, a $1.4 trillion year-end government funding piece of legislation that includes $900 billion in COVID relief.
Key elements of this legislation for post-acute providers include:
· $3 Billion Add-On to Physician Fee Schedule: this will reduce the projected 9% cut to Medicare Part B therapy services to 3.6%.
· Extension of Sequestration Relief: the 2% Medicare sequestration set to resume 1/1/2021 will be delayed 3 months.
· Freeze on use of the new “complexity” code: to help mitigate the cuts to the Physician Fee Schedule, this legislation places a 3-year moratorium on the use of HCPC G2211, a new code that was to be used by primary care physicians to indicate an office visit had “additional complexity”.
· SNF Value-Based Purchasing Program: allows the HHS Secretary to add up to 10 quality measures, including functional status, patient safety, care coordination, or patient experience, to the SNF VBP program. Currently, the only quality measure that is part of the SNF VBP and the associated incentive payment is the SNF 30-Day All-Cause Readmission Measure.
· MedPAC Report to Congress: under the IMPACT Act, the Medicare Payment Advisory Commission (MedPAC) was required to submit a report to Congress by March 2023 that would include a post-acute care value-based payment program prototype. This legislation will move up that deadline by 1 year to March 2022, which may lead to additional payment reform for post-acute providers sooner than anticipated.
This legislation is still in need of the President’s approval, which is expected to happen this week. While there may be some changes to the legislation based prior to the President’s signature, the key elements impacting post-acute providers are not expected to change.
Preferred Therapy Solutions continues to provide its partners with vital information that may impact rehabilitation management, reimbursement policies, and clinical programs, supported with compliance and regulatory requirements that are necessary for a thorough understanding of practices and procedures. If you have any questions, please contact Matt Nash, Vice President of Strategic Development at email@example.com.
The Centers for Medicare and Medicaid Services (CMS) issued the CY 2021 Medicare Physician Fee Schedule (PFS) Final Rule on Dec 1st, 2020. In this Final Rule, CMS is finalizing its proposals to update Med B payment policies, payment rates, telehealth policies, and quality provisions for services furnished under Med B on or after January 1, 2021.
WHAT YOU NEED TO KNOW
2021 Conversion Factor and Payment Reduction
CMS has made the decision to finalize its policy on increasing payment for E/M codes in order to place more resources in specialties that provide primary care. Unfortunately, because of budget neutrality requirements, the increase in these E/M codes forces a reduction in payment in other specialties. The overall decrease in payment for PT and OT services will be approximately 9% in calendar year 2021 and a 6% decrease for ST. The 2021 conversion factor will be $32.41. This is a 10.2% decrease from the 2020 conversion factor of $36.09.
On October 30th, the House of Representatives introduced bipartisan legislation that provides for a potential fix to the fee schedule cuts slated to take effect on January 1, 2021. The bill is entitled, the Holding Providers Harmless from Medicare Cuts During COVID-19 Act of 2020 (H.R. 8207). The bill would ensure payments to providers expecting to receive a cut in 2021 under the E/M proposal are kept stable at 2020 levels for the next two years. The intent is to get this bill included in a legislative package before the end of the year.
Other Highlights of the Final Rule:·
· A 2021 annual therapy threshold dollar amount was not included in the final rule
· Therapy students can document in the medical record so long as it is reviewed and verified (signed and dated) by the billing therapist
· Grants a physical therapist (PT) and occupational therapist (OT) the discretion to delegate the performance of maintenance therapy services, as clinically appropriate to a physical therapist assistant (PTA) or an occupational therapy assistant (OTA)
· The value of PT/OT/ST evaluation codes have been increased
· CMS stated they do not have the authority to add PT/OT/ST providers to continue telehealth services once the PHE ends
Preferred Therapy Solutions is part of a large coalition of provider organizations, who are troubled that during a pandemic is not the time to reduce payments to essential Medicare providers.
We still have hope and we are requesting Congress to include legislation in any year-end proposal to prevent these arbitrary Medicare cuts.
Congress needs to understand the difficult environment we are working in daily and to realize these cuts would have a devastating impact on long-term care. Please click on the link below and contact your member of Congress.
LINK FOR CONTACTING CONGRESS: https://bit.ly/3kHGpBU
The pre-publication final rule can be found Here.
CMS’ Fact Sheet on the final rule can be found Here.
|Preferred Therapy Solutions continues to provide its partners with vital information that may impact rehabilitation management, reimbursement policies, and clinical programs, supported with compliance and regulatory requirements that are necessary for a thorough understanding of practices and procedures. If you have any questions, please contact Maria Maggi, Vice President of Quality, Outcomes, and Compliance at: firstname.lastname@example.org|