2013 – The Year of

ChangeHow it affects hospital-based

rehabilitation

LEARNING OUTCOMES

Identify new therapy codes

Describe new therapy billing requirements

MAJOR ISSUES OF CHANGE

THERAPY CAP/FEE SCHEDULE

MPPR (MULTIPLE PROCEDURE PAYMENT REDUCTION)

FUNCTIONAL LIMITATION REPORTING

PQRS

THERAPY CAP

MEDICARE CONVERSION FACTOR FROZEN AT 2012 LEVELS (AVERTS A 26.5% CUT IN PAYMENTS)

REMAINS AT $1900 KX AUTOMATIC EXTENSION

PT/SPEECH VS OT

NOW A $3700 REQUIRED MANUAL REVIEW

MPPR

APRIL 1 DEADLINE

50% REDUCTION IN THE FACILITY PORTION OF CPT CODES

WAS ORIGINALLY SUPPOSED TO BE 25% OF FIRST AND 50% OF SUBSEQUENT CODES

ESTIMATED 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 DISCHARGE

THERAPIST’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 EPISODE

TESTING JANUARY 1-JULY 1

AFTER 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 MODIFIERS

MODIFIER IMPAIRMENT LIMITATION RESTRICTION

CH 0 PERCENT IMPAIRED

CI 1-20 % IMPAIRED

CJ 20-40% IMPAIRED

CK 40-60% IMPAIRED

CL 60-80% IMPAIRED

CM 80-100% IMPAIRED

CN 100% IMPAIRED

LEARNING OUTCOMES

Identify new therapy codes

Describe new therapy billing requirements

CONTACT

Joe Sapp

Joe@itcmgt.net

229-315-9291