News & Articles
CMS Repeals crucial edits
APTA and its members engaged in extensive advocacy efforts to convince CMS to rethink its decision. On January 24, CMS announced that it would do away with the most problematic changes and, for the most part, return to the coding rules PTs used in 2019. What it means: PTs will be able to return to billing for therapeutic activities (97530) delivered on the same day to the same patient as PT or occupational therapy evaluations billed under codes (97161, 97162, 97163, 97165, 97166, 97167). PTs (and occupational therapists) will also be allowed to return to billing the group therapy code (97150) with those evaluation codes. Keep in mind: There are still lots of details to be worked out, including the timeline for CMS to notify Medicare Administrative Contractors of the change, and whether it’s retroactive. Additionally, a few of the January 1 restrictions remain, primarily related requirements around the use of the 59 modifier/X modifier. CMS has not yet shared details on effective date and the process for implementation of the changes. In a January 24 letter to APTA and other associations, Cathy Cook, MD, medical director of CMS coding contractor Capitol Bridge, wrote that “after reviewing this issue more closely, CMS has made the decision to retain the edits that were in effect prior to January 1, 2020.” The return to the pre-January 1 coding environment reverses a CMS National Correct Coding Initiative edit that prevented PTs and OTs from billing for therapeutic activities (97530) if any of the PT or OT evaluation codes were billed the same day for the same patient. That prohibition crossed disciplines that...Palmetto GBA will host Ask the Contractor Teleconferences (ACTs)
Palmetto GBA will host Ask the Contractor Teleconferences (ACTs) on various topics throughout the year. Mark your calendars now so that you don’t miss a chance to learn valuable information about how Medicare guidelines affect your practice! Benefits of Attending Teleconferences Save time and money. You can dial in directly from your office at no charge and with no travel time. Learn from others. Teleconference participants learn from each others’ discussions and receive useful clarification regarding different Medicare policies and initiatives. We answer provider/supplier questions associated with coverage, guidelines and reimbursement. If you subscribe to our free email update service, we will notify you in advance of all the important details All materials that are developed for the ACTs are available on our website at Workshop Handouts Questions and answers will also be posted after the teleconferences Palmetto GBA will host Ask the Contractor Teleconferences (ACTs) on various topics throughout the year. Mark your calendars now so that you don’t miss a chance to learn valuable information about how Medicare guidelines affect your practice! Benefits of Attending Teleconferences Save time and money. You can dial in directly from your office at no charge and with no travel time. Learn from others. Teleconference participants learn from each others’ discussions and receive useful clarification regarding different Medicare policies and initiatives. We answer provider/supplier questions associated with coverage, guidelines and reimbursement. If you subscribe to our free email update service, we will notify you in advance of all the important details All materials that are developed for the ACTs are available on our website at Workshop Handouts Questions and answers will also be posted...CSM Meetings – Denver CO
APTA Combined Sections Meetings are scheduled in Denver, Colorado February 12 – 15, 2020. Register HERE Future dates: CSM 2020 – Feb 24 – 27 – Orlando, Florida CSM 2022 – Feb 1 -4 – San Antonio, Texas CSM 2023 – Feb 22 – 25 – San Diego, California CSM 2024 – Feb 14 – 17 – Boston, Massachusetts...New CCI Edits!!
Effective January 1, 2020 Physical and Occupational therapy when providing an initial evaluation you cannot provide therapeutic activities (code 97530 ) and therapeutic procedures, group, 2 or more individuals (code 97150) during the same visit. When providing manual therapy (code 97140) you must include a 59 modifier. The modifier that’s used to indicate that a code represents a service that is separate and distinct from another service to which it is paired. You can see all the CCI edits...MIPS – Are you Required or Eligible to report?
Although you checked in December 2019, check again (and maybe again) on your status to report. Check using each physical therapist NPI number. Click HERE to check your statusSubmit 2019 MIPS – Submission is open
PERFORMANCE YEAR 2019 Submission Window is Open You can now sign in to submit your PY 2019 data. Data can be submitted and updated any time unit March 31, 2020, 8PM EDT when the submission window closes. You can also opt-in to participate in MIPS if you meet certain criteria. Click HERE to create a log in to submit your data or to...Medicare Quality Programs: Transitioning from PQRS to MIPS Call — January 24
uesday, January 24 from 2 to 3:30 pm ET To register or for more information, visit MLN Connects® Event Registration. During this call, find out how to complete the final reporting period for the legacy Medicare quality reporting programs and transition to the Merit-based Incentive Payment System (MIPS). A question and answer session follows the presentation. Agenda: Wrapping Up the 2016 Program Year for the Physician Quality Reporting System (PQRS), Medicare Electronic Health Record (EHR) Incentive Program, and Value-Based Payment Modifier (VM) Transitioning to MIPS Timeline for PQRS, EHR, VM, and MIPS programs with submission timeframes and other key milestones Resources Target Audience: Physicians, Accountable Care Organizations; Medicare eligible professionals; therapists; medical group practices; practice managers; medical and specialty societies; payers; and insurers. This MLN Connects Call is being evaluated by CMS for CME and CEU continuing education credit (CE). Refer to the call detail page for more information....2015 Physician Quality Reporting System Feedback Reports and 2015 Annual Quality and Resource Use Reports Available Soon
The 2015 Physician Quality Reporting System (PQRS) feedback reports will be available in September 2016 for individual eligible professionals (EPs) and PQRS group practices. The PQRS feedback reports will provide the final determination on whether or not participants met the PQRS criteria for avoiding the 2017 PQRS negative payment adjustment. Detailed information about the quality data submitted by the provider is also included. The 2015 PQRS feedback reports reflect data from the Medicare Physician Fee Schedule (PFS) claims received with dates of service from January 1, 2015 – December 31, 2015 that were processed into the National Claims History (NCH) by February 26, 2016. A PQRS feedback report will be generated for each Taxpayer Identification Number/National Provider Identifier (TIN/NPI) combination that reported PQRS data or that submitted Medicare PFS claims that included denominator-eligible events but did not submit PQRS data. The feedback reports will include all measures reported by the NPI for each submission mechanism used. The data in these reports may help an individual EP or PQRS group practice determine whether or not it is necessary to submit an informal review request. Detailed submission information for PQRS group practices that submitted via the GPRO Web Interface will be available in the Quality and Resource Use Reports (QRURs). Additional information about the 2015 PQRS feedback reports and how to request an informal review will be available on the PQRS website and through the QualityNet Help Desk at 1-866-288-8912 or qnetsupport@hcqis.org. The 2015 Annual Quality and Resource Use Reports (QRURs) will also be available in September 2016 for groups with 2 or more EPs and solo practitioners. Groups and solo...2016 PQRS Reporting Measures Series, Session 3: MAV and How to Get Started
The Centers for Medicare & Medicaid Services (CMS) is pleased to announce the third session of a three-part Virtual Office Hours series regarding 2016 Physician Quality Reporting System (PQRS) quality measures. The series includes three separate sessions that cover topics related to PQRS measures, measure-specific definitions, measures-related resources, and next steps for participating in 2016 PQRS.
Provider Enrollment Revalidation – 2016 (Cylce 2)
The Centers for Medicare & Medicaid Services (CMS) has completed its initial round of revalidations and will be resuming regular revalidation cycles