Please note that this article contains information that is only relevant to American clinics.

 

As if the news about the removal about the removal of Medicare’s therapy cap exceptions wasn’t bad enough, there are some big changes to the reimbursement payouts for several popular CPT codes. In this article, we’ll discuss two of the most-common CPT codes for PTs providing Medicare Part B services that are affected by these payment changes in 2018.

 

If you read our series on how the CMS determines the dollar value of each CPT code, then you’re no stranger to the “Resource Based Relative Value Scale” (RBRVS). The RBRVS accounts for factors such the skill and training required to perform certain types of treatment, along with the costs associated running a private practice facility in any given region. The CMS used this scale to make some changes to the payouts for some very popular CPT codes in 2018.

 

Two of the most common CPT codes billed by therapists are therapeutic exercise (CPT 97110) and manual therapy (CPT 97140). As per the updates to the CPT codes, the 2018 payment rate for CPT 97110 therapeutic exercise has been reduced by $1.97, and the payment rate for CPT 97140 manual therapy has been reduced by $2.38.

 

When you look at those numbers individually, it doesn’t seem like a whole lot. But when you do the math, $1.97 really begins ton add up. Let’s look at an example.

 

Say, for instance, that your therapists collectively provide 100 units of CPT 97110 therapeutic exercise per week. That loss of $1.97 per unit just because a loss of $197.00 for the week. Within 1 month, that represents a loss of $788.00. And over the course of a year, nearly $10,000—and of course, this is assuming that your facility is being compensated the full amount to begin with. But it isn’t all doom and gloom for PTs.

 

A recent article from Gawenda Seminars and Consulting stated that “CPT codes 97112 (neuromuscular reeducation) and 97530 (therapeutic activities) are seeing an increase in their payment rate in 2018 compared to 2017.” However, it is also advised that you never bill a CPT code simply because it has a higher payment rate. It is of the utmost importance that the code you bill accurately reflects the services you or your therapists provided during that session.

 

We hope you found this article helpful. For more great information about Medicare, head over to the Gawenda Seminars and Consulting website and learn more about the benefits of becoming a Gold Member.

Please note that this article contains information that is only relevant to American clinics. 

 

Do you ever find yourself wondering whether or not you need to document the time for your Medicare Part B patients? Perhaps it’s unclear if you need to record the length of the entire appointment, or if you just need to keep track of the time for an individual CPT code. Fortunately the folks from Gawenda Seminars and Consulting have written an article addressing this issue.

 

The article states that “For outpatient therapy services provided under Medicare Part B, the required elements for documentation of time are: total ‘timed code’ treatment in minutes, and total ‘treatment time’ in minutes.” Let’s distinguish the difference between ‘timed’ and ‘untimed’ CPT codes.

 

Click here to read our articles about timing therapy notes for Medicare patients.

 

Certain CPT codes are considered ‘timed’. This means that a unit of treatment for a code that is considered ‘timed’ will require that you log how much time was spent performing that specific treatment. A good example of which is the manual therapy CPT code (97140), which accounts for 15 minutes of treatment. So, if you only spent 15 minutes providing manual therapy, you can only bill 1 unit of CPT 97140, and you will need record the 15 minutes spent performing that treatment–this is your ‘total timed minutes’. 

 

Other CPT codes are considered ‘untimed’. Performing treatment based on an ‘untimed’ CPT code means that you won’t need to record the specific amount of time spent performing the treatment. Regardless of whether you spend 10, 20, or 30 minutes assisting a patient with mechanical traction (CPT 97012), you can only bill 1 unit. However, you still must record the amount of time in your ‘total treatment time’.

 

To further illustrate the difference between ‘timed’ and ‘untimed’ treatment codes, let’s create an example: A patient visits your facility for their regularly scheduled therapy session.

 

Let’s say that you provided 30 minutes of manual therapy–a timed CPT code. When you’re finished with the manual therapy, you set them up for 20 minutes of mechanical traction–an untimed code. Now let’s review the total amount of time that ought to be recorded in your documentation:

 

– Total ‘timed’ treatment: 30 minutes

 

– Total treatment time: 50 minutes

 

Because mechanical traction is an ‘untimed’ treatment code, it is the only counted in the total treatment time. Thus, only one unit may be billed. On the other hand, manual therapy is a ‘timed’ treatment code, and you may bill 2 units (15 mins each). And this should shed some light on how to document time for Medicare patients.

 

We hope you found article helpful. For more Medicare related information like this, be sure to head over to Gawenda Seminars and Consulting and learn more about how to become a Gold Member.

Please note that this article contains information that is only relevant to American clinics.

 

Every year, the Centers for Medicare and Medicaid Services (CMS) implement changes to the Medicare Physician Fee Schedule (MPFS). These changes are intended to ensure that patients can access the healthcare services they require. They’re also implemented to ensure that therapists are receiving adequate reimbursement and can afford to continue offering their services. In this article, we’ll be reviewing the changes to the MPFS implemented by the CMS that will be affecting the 2018 calendar year.

 

Private practice clinics, outpatient facilities in hospitals, and skilled nursing facilities are among the practice settings to be affected by these new rules.

 

To start, there has been a change to the therapy cap threshold in 2018. The good news is that the dollar amount is being raised to $2,010.00. The bad news, however, is that they’re doing away with the process used to review claims exceeding $3,700.00. In fact, a recent article from Gawenda Seminars and Consulting stated that “Without a therapy caps exceptions process, the therapy caps will be applicable without any further medical review, and any use of the KX modifier on claims for these services by providers of outpatient therapy services will have no effect.”

 

Those of you offering orthotics at your facilities and are accustomed to billing CPT code 97760–and there’s been a slight change to this code. From 2018 onward, it is only to be used for the initial visit. To further explain, you may bill this CPT code during the patient’s initial assessment when you are determining the type of orthotic required, fitting it, training the patient on how to use it, etc. In subsequent visits, you will no longer be billing CPT code 97762, which has been deleted. It’s been replaced by CPT code 97763. And for the initial assessment for patients with prosthetics, CPT code 97761 has also been revised to specifically mention the initial encounter.

 

There have also been some changes to the cognitive therapy CPT codes, too. The most notable of which is the removal of CPT code 97532 (development of cognitive skills to improve attention, memory, and problem solving). This code has been replaced by CPT code 97127 (therapeutic interventions that focus on cognitive function).

 

In sum, there are a lot of changes to Medicare in 2018, and this article provides a mere glance of them. To learn more about how these changes will affect your private practice or outpatient facility, head over to the Gawenda Seminars or the official Medicare website.

Please note that this article contains information that is only relevant to US clinics.

 

Every year, the Centers for Medicare and Medicaid (CMS) propose some changes to the CPT codes that we know and love. intended to bring clarification to the complicated process of medical billing, it has become incredibly important to stay up-to-date with the latest to CPT code changes. Coming into effect on January 1, 2018, here is a brief review some of the 2018 changes to CPT codes affecting outpatient rehabilitation providers.

 

Interested in perusing the document detailing all of the revisions to payment policies and CPT codes for the 2018 calendar year? Click here.

 

Updating CPT Codes for 2018

 

A recent article from Gawenda Seminars and Consulting lists several CPT codes that are either changing, or being removed, for the 2018 calendar year. They are as follows:

 

– Multi-layer compression system CPT codes 29582 and 29583

– Orthotic and management training (CPT code 97760)

– Prosthetic management and training (CPT code 97761)

– Orthotic/prosthetic checkout (CPT Code 97762)-

– Development of cognitive skills (CPT code 97532)

 

Now, if you want to find out exactly how those CPT codes are changing, we recommend cross-referencing them with the document detailing the upcoming changes to Medicare in 2018. But here’s a hint: the change to the last CPT code on the list (97532) has to potential to be particularly impactful to SLPs.

 

Changes to Quality Initiatives  

 

The CMS is making quality reporting a little easier in 2018—they’re reducing the required number of quality measures reported from nine to six. These changes are being implemented in an effort to reduce the payment penalties practitioners receive when they fail to report the correct information.

 

We hope you found this article helpful. For more great information about Medicare, be sure to check out the Gawenda Seminars and Consulting website and learn more about the benefits of becoming a Gold Member.