The American Physical Therapy Association (APTA) recently announced Centers for Medicare and Medicaid Services’ (CMS) release of the final 2014 Medicare physician fee schedule. The Medicare physician rule reportedly sets the therapy cap on outpatient services at $1,920.
The APTA adds that the rule also announces a 20.1% reduction in Medicare payment rates for physical therapists (PTs), physicians, and other healthcare professionals. This cut is linked to the sustainable growth rate (SGR) formula currently being discussed by Congress. The APTA reports that the new rule updates payment amounts for PTs, physicians, and other healthcare professionals, makes changes to the Physician Quality Reporting System (PQRS), and revises other payment policies.
According to an APTA news release, the final rule’s 20.1% reduction is the conversion factor used to determine Medicare payment rates, a reduction generated by the SGR formula. For 10 years, the association points out, Congress has enacted legislation preventing the reduction every year. The release notes that the president’s budget aims to stop these cuts and find a permanent solution to this issue, while Congress currently works to address an alternative payment method that would include the permanent repeal of the SGR. The APTA explains that should Congress neglect to stop the 20.1% payment cut, the aggregate payment for outpatient physical therapy services would remain unchanged from 2013 as a result of changes in practice expense, work, and malpractice relative value units.
In addition to setting the therapy cap at $1,920 for 2014, the APTA points out that the rule makes changes to payments to critical access hospitals (CAHs) beginning January 1, 2014. The rule subjects CAHs to the therapy caps, as well as any potential extension of the therapy cap exceptions processes, in the same manner as other providers of outpatient therapy services. The therapy cap automatic exceptions process and the manual medical review process, applicable to outpatient therapy expenditures exceeding $3,700 per beneficiary, will expire on December 31, 2013 unless Congress acts to extend them.
The APTA notes that it supports CMS’ finalized proposal that requires individuals performing “incident-to” services in the physician’s office to meet any applicable state requirements, including licensure. The release states in effect, this would allow the federal government to recover funds paid if services are not furnished in accordance with state law.
PQRS are also slated to see changes for 2014, APTA says. PTs, physicians, and other eligible professionals will be able to avoid the 2016 2.0% PQRS penalty by reporting at least three individual measures through claims or registry for 50% or more of eligible Medicare patients in the 2014 reporting period. In spite of opposition from the APTA and other stakeholders, CMS will reportedly also increase the number of PQRS quality measures that providers must report either via claims or registry from 3 to 9 to qualify for the 0.5% bonus payment in 2014. CMS will maintain the current 12-month calendar year reporting period for the PQRS program but will eliminate the option to report on measures groups through claims.