News & Articles

Final Policy, Payment, and Quality Provisions Changes to the Medicare Physician Fee Schedule for Calendar Year 2021

CY 2021 PFS Ratesetting and Conversion Factor CMS is finalizing a series of standard technical proposals involving practice expense, including the implementation of the third year of the market-based supply and equipment pricing update, and standard rate-setting refinements to update premium data involving malpractice expense and geographic practice cost indices (GPCIs). With the budget neutrality adjustment, as required by law, to account for changes in RVUs including significant increases for E/M visit codes, the final CY 2021 PFS conversion factor is $32.41, a decrease of $3.68 from the CY 2020 PFS conversion factor of $36.09. The PFS conversion factor reflects the statutory update of 0.00 percent and the adjustment necessary to account for changes in relative value units and expenditures that would result from finalized policies....

October 5, 2020 – Portal for Reporting How Relief Money Was Spent Opens Jan. 15 — With a Change

The HHS portal will be open for 30 days, and providers have to adopt a new way of calculating revenues lost due to the pandemic. As APTA reported on Sept. 23, the U.S. Department of Health and Human Services is continuing to provide details on how providers who received relief funds need to account for how the money was spent, with the latest details including a change in how lost revenue should be calculated. That shift has raised concerns, with critics saying that the new approach may increase the number of recipients who have to return funds, and could make it hard for some smaller businesses to even come up with the calculations in the first place. The change is part of a recently announced shift in HHS’ plans for how relief fund recipients are to report use of the money, from a quarterly reporting system to a one-time accounting delivered via an online portal. HHS later confirmed that the portal will open on Jan. 15. Feb. 15 will be the first reporting deadline for all providers on the use of funds, and July 31 will be the final reporting deadline for providers who did not fully expend the funds before Dec. 31, 2020. Information providers can expect to provide for the reporting requirements include lost revenues, expenses attributable to coronavirus, basic organization information, other assistance received in 2020, and non-financial information (employees, patients, etc.). Among the reporting requirements released with the updated guidance on Sept. 19 is a change that has sparked criticism from the American Hospital Association and other organizations — a new definition of “lost revenue”...

October 2, 2020 – New CPT Code 99072 Available to PT & OTs Could Help Offset Coronavirus-Related Expenses

Recently, the American Medical Association published an update to the Current Procedural Terminology (CPT®) code set that includes a code for reporting expenses incurred as a result of the necessary public health response to the COVID-19 pandemic. The code — 99072 — is a new practice expense code that describes the additional supplies and clinical staff time required to stop the spread of the coronavirus while still providing safe in-person visits. According to coding guidance from AMA, the additional supplies, materials, and clinical staff time covered under the new CPT code include additional personal protective equipment, patient symptom checks over the phone and upon arrival, donning and removing PPE, and increased sanitation measures and supplies to prevent the spread of communicable disease. The code should be reported only once per in-person patient encounter (office visit or other services), regardless of the number of services provided during the visit, the guidance says, but the use of the code isn’t dependent on a specific patient diagnosis. The AMA/Specialty Society RVS Update Committee worked with 50 specialty societies, including APTA, over the summer to collect data on the costs of maintaining safe offices and time spent to educate therapists and their patients during the public health emergency. Although 99072 describes “clinical staff time,” AMA notes that the code also can be reported when qualified health care providers perform activities normally carried out by clinical staff, such as pre-visit screening or equipment and room...

October 2, 2020 – Renewal of Determination That A Public Health Emergency Exists

As a result of the continued consequences of the Coronavirus Disease 2019 (COVID-19) pandemic, on this date and after consultation with public health officials as necessary, I, Alex M. Azar II, Secretary of Health and Human Services, pursuant to the authority vested in me under section 319 of the Public Health Service Act, do hereby renew, effective October 23, 2020, my January 31, 2020, determination, that I previously renewed on April 21, 2020, and July 23, 2020, that a public health emergency exists and has existed since January 27, 2020, nationwide. The public health emergency has been extended for another 90 days (January 23, 2021) This renewal, in conjunction with the national health emergency declaration issued by the President on March 13, 2020, means that PTs and PTAs in private practice and facility-based physical therapy providers will continue to have access to the temporary Medicare regulatory waivers and new rules that afford providers the flexibility to respond to COVID-19 pandemic, including telehealth coverage.  Access the notice...

October 1, 2020 – The President signed into law a bipartisan government funding bill that averts a shutdown and will relax Medicare loan repayment terms for healthcare providers.

The bill would give providers one year after the Medicare Accelerated and Advance Payment Program loan was issued before recoupment would begin, an extension from 120 days under current law. The recoupment rate would also be lowered from its current 100% level to 25% for the first 11 months of repayment, and 50% for the six months afterward. Providers would have 29 months after payments to pay back the funds in full before interest would begin to accrue. The interest rate would be lowered from the current rate of 9.6% to 4%. Click here to view the bill. To view the section by section click...

OSHA Town Hall

OSHA expert to remind us of basic housekeeping rules and what additionally needs to considered to address COVID-19 needs.

WV The Health Plan – “2020 THP Updates with Emphasis on COVID-19”.

You are invited to join The Health Plan via webinar on Wednesday, April 22, 2020 from 12:00 PM to 1:00 PM EDT to learn of changes that may impact your practice in 2020. In addition to general updates, this free webinar will contain information pertinent to THP’s response to the COVID-19 pandemic including co-pays, authorizations, telehealth services and coronavirus testing codes. Attendance may qualify for one continuing education unit. Please confirm with your accrediting agency. Access the webinar registration page here. After registering, you will receive a confirmation email containing information on how to connect to the webinar through video and audio channels. We anticipate that the content of the webinar will use the full hour allotted for the presentation and there may not be time to address questions following the webinar.  You are encouraged to send questions prior to the webinar to providernotification@healthplan.org. We will make every effort to answer pre-submitted questions during the presentation.    ...

Latest Relief Package: Options for Small Businesses The CARES Act signed into law on March 27 is aimed at providing relief in a wide range of areas in response to the COVID-19 pandemic.

Latest Relief Package: Options for Small Businesses The CARES Act signed into law on March 27 is aimed at providing relief in a wide range of areas in response to the COVID-19 pandemic. Here’s what the package offers to small businesses. The federal government has acknowledged that small businesses may be especially hard hit by the COVID-19 pandemic and has responded by establishing provisions aimed at lessening some of the impact. The latest measure, known as the CARES Act, includes some of the most extensive small business relief to date. Here’s an overview of the small business-related relief provisions in the CARES Act. Details on these provisions, as well as on other pandemic-related resources, are available from the U.S. Small Business Administration, the U.S. Chamber of Commerce, the U.S. Department of the Treasury, and the Internal Revenue Service. Paycheck Protection Program Loans The legislation creates the Paycheck Protection Program, a new loan product within the Small Business Administration’s 7(a) Loan Program. Existing and new SBA lenders will be able offer these loans to eligible small businesses. The new loan, with an interest rate of up to 4%, will be 100% guaranteed by the SBA. Funds may cover payroll costs, including continuation of group health care benefits during periods of paid sick, medical, or family leave, and insurance premiums; employee salaries and commissions; payments of interest on any mortgage obligation, rent, and utilities; and interest on any other debt obligation incurred before February 15, 2020. Businesses and charitable nonprofits with fewer than 500 employees, sole proprietors, independent contractors, and self-employed individuals are eligible for the loans. A business can borrow up to 2.5 times...

OPTA Introduces HB 547 – Fair Co-pay Legislation

March 10, 2020. Rep. Jeff LaRe (R-77) introduced legislation that would create co-pay parity for physical and occupational therapy services. Currently, insurance carriers classify PTs and OTs as “specialists” and patients are often subjected to higher co-pays than they would be for seeing primary care providers. The goal of the bill is to remove the cost factor in choosing between physical and occupational therapy services or prescription opioids in treating pain management. Allowing therapy to be a more affordable option and removing this barrier to access is one means of addressing the opioid epidemic. As defined in the bill, cost sharing is an out-of-pocket expense (i.e. copayment, coinsurance, deductible) made by an individual for services rendered by a physical or occupational therapist. Typically, the out-of-pocket expense for this type of therapy falls into the specialist category. The legislation will prohibit the cost sharing requirement for these services to not be greater than the cost sharing requirement for services provided by an individual’s primary care physician. The OPTA and OOTA believe creating co-pay alignment with that of a primary care physician will allow more Ohioans to access the services of physical and occupational therapists. If passed Ohio would join other states such as Kentucky in enacting this policy. TAKE ACTION – CONTACT YOUR HOUSE MEMBER TODAY!1) Login at www.ohiopt.org2) Click on the Advocacy tab3) Click TAKE ACTION4) Click on HB 547 – Fair Co-Pay  Use the widget to send emails and social media posts to your House member! We’ll continue to post updates on this legislation, and the PT Compact bill, as information becomes available. Thank you Rep. LaRe for your support of the physical and occupational...