2013 – The Year of

ChangeHow it affects hospital-based

rehabilitation

LEARNING OUTCOMESIdentify new therapy codesDescribe new therapy billing requirements

MAJOR ISSUES OF CHANGE

THERAPY CAP/FEE SCHEDULEMPPR (MULTIPLE PROCEDURE PAYMENT REDUCTION)FUNCTIONAL LIMITATION REPORTINGPQRS

THERAPY CAPMEDICARE CONVERSION FACTOR FROZEN AT 2012 LEVELS (AVERTS A 26.5% CUT IN PAYMENTS)REMAINS AT $1900 KX AUTOMATIC EXTENSIONPT/SPEECH VS OTNOW A $3700 REQUIRED MANUAL REVIEW

MPPRAPRIL 1 DEADLINE50% REDUCTION IN THE FACILITY PORTION OF CPT CODESWAS ORIGINALLY SUPPOSED TO BE 25% OF FIRST AND 50% OF SUBSEQUENT CODESESTIMATED TO REDUCE OVERALL PAYMENTS 6-7%EXAMPLE: 97110

FUNCTIONAL LIMITATION REPORTING

NON-PAYABLE G CODES WILL BE ASSIGNED AT INITIAL EVALUATION, EACH 10TH VISIT, AT DISCHARGETHERAPIST’S PROJECTED GOAL FOR FUNCTIONAL STATUS AT THE END OF TREATMENT WILL BE REPORTED ON THE FIRST CLAIM FOR SERVICES AND AT THE END OF THE EPISODETESTING JANUARY 1-JULY 1AFTER JULY 1, CLAIMS SUBMITTED WITHOUT THE APPROPRIATE G-CODES AND MODIFIERS WILL BE RETURNED UNPAID

EXAMPLE OF G CODESMOBILITY: WALKING AND MOVING AROUND

G8978: Mobility: walking & moving around functional limitation, current status, at therapy episode outset and at reporting intervals

G8979: Mobility: walking & moving around functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting

G8980: Mobility: walking & moving around functional limitation, discharge status, at discharge from therapy or to end reporting

EXAMPLES OF MODIFIERSMODIFIER IMPAIRMENT LIMITATION

RESTRICTIONCH 0 PERCENT IMPAIREDCI 1-20 % IMPAIREDCJ 20-40% IMPAIREDCK 40-60% IMPAIREDCL 60-80% IMPAIREDCM 80-100% IMPAIREDCN 100% IMPAIRED

LEARNING OUTCOMESIdentify new therapy codesDescribe new therapy billing requirements

CONTACTJoe SappJoe@itcmgt.net229-315-9291