On January 1, 2020 CMS implemented a change to coding that prevented PTs and OTs from billing evaluation codes and therapeutic activity and/or group therapy codes delivered on the same day. Prior to 2020, the APTA advocated for telehealth’s widespread adoption and expansion. CHC Treatment & Authorization 2020-21 ... Insurance Claim Form (Espanol) 2020-21. The courses were so relevant and very clearly written! Here’s a recent update from Medicare. The proposed rule didn’t bring a lot of light to the unexpected changes to MIPS. This past week healthcare giant Humana announced t. hat it’s falling in line with rules from the Centers for Medicare and Medicaid Services designed to establish an 85% payment differential for therapy services delivered “in whole or in part” by a PTA or occupational therapy assistant. In an April 14 letter to Health and Human Services Secretary Alex Azar, a group of Representatives asked that PTs, occupational therapists, speech language pathologists and … Compliance Medicare Modifiers 2020 What the rule will require Effective January 1 2020, all therapy services “furnished in whole or in part by” a PTA or a COTA, will be required to include one of the following modifiers: CQ Modifier: Outpatient physical therapy services furnished in whole or in part by a physical therapist assistant. The targeted medical review threshold will be increased from $3,000 back to $3,700 as it was in prior years. It is not clear whether CMS has any plans to include the Cost Category as part of the performance weighting for PT and OT. The Centers for Medicare & Medicaid Services (CMS) released the proposed FY 2021 Medicare Physician Fee Schedule (MPFS) Rule and Fact Sheet on August 3, 2020. At least 50% of a group’s NPIs must perform the same activity for any continuous 90 Beginning in 2021, QCDRs and Qualified Registries will be required to support multiple performance categories and QCDRs will have additional requirements to “foster improvement in the quality of care”. However, it is uncertain if CMS has any plans to include the Interoperability Category as part of the PT and OT performance weighting. While this is good news for many therapists and companies, there are still many details to be worked out, including the timeline for CMS to notify Medicare Administrative Contractors of the change, and whether it’s retroactive. This payment rate is 85% of the rate physical therapists and occupational therapists are paid. Since it contains 1704 pages, it’s not an easy read. There are main areas that are of interest to private physical therapy and occupational therapy practices are: Consistent with CMS, Humana is requiring use of code modifiers in 2020, with no changes to payment until 2022. 30% for cognitive therapy beginning in 2020. Here are some of the important details and summary: As stated above, no unexpected changes have been made including the low volume threshold, MIPS eligibility, data collection, or measure scoring. Although the 15 percent payment reduction does not go into effect until 2022, the modifier requirement goes into effect for claims with dates of service on or after Jan. 1, 2020. Highly recommend this course. APTA will provide details as they become available.”. Weekly News Scan: 2020 CMS Proposed Rule is Here, Looking at Physical Therapy Holistically. 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