Page 12 - OPTA September 2018

Payment
Policy Report
Berni Willis – Payment Policy Specialist
CMS 2019 THERAPY PROPOSED CHANGES
Medicare has proposed new rules that will bring about changes beginning in 2019 and progressing through 2022. There will be a change in the definition of the Therapy Modifier (GP) and the addition of a Modifier which will define treatment provided by
a physical therapist assistant . Additionally, on the horizon is the Merit Based Incentive Payment System (MIPS) reporting to be effective January 1, 2019 .
THERAPY MODIFIER (GP) DESCRIPTION DEFINED
Currently reads as - Services are delivered under an outpatient physical therapy plan of care . Proposed description - Services fully furnished by a physical therapist or by or incident to the services of another qualified clinician .
Reporting categories include Quality (50%), Improvement Activities (15%), Advancing Care Information (25%) and Cost (10%) . You may be excluded from participating in MIPS during your first calendar year participating with Medicare Part B, if you are billing under $90,000 or providing care for less than 200 patients in a 12-month calendar period .
Three options are available to report . Individual (single TIN); Group (single TIN with 2 or more providers) and Virtual Group (Group created with 10 or more eligible providers that agree to report together for period of one year .)
Physical Therapy is to report a total of six measures . Measures currently available to report:
128 BMI; 130 Current Meds; 131 Pain Assessment; 154 Fall Risk; 155 Falls POC and #182 Function Outcome Assessments .
UNITED HEALTH CARE PILOT PROGRAM (TBD)
UHC is creating a pilot program for physicians to refer both physical therapists and chiropractors
first prior to pain meds and surgery. The program is going to be unique in that they want to streamline the process with interfacing with the provider's EMR system so they can track the progress and outcome of the patient . Currently, the pilot program is being considered to begin in Dayton, Ohio . The kinks are still being worked out and there has been no firm release date .
TRICARE
The language for usage of PTAs is to be released at the beginning of 2019 . At that time PTAs will be able to provide care to Tricare patients .
For more information, contact the OPTA office at:
opt@ohiopt.org.
12 | September 2018 | OPTA
REDUCED PAYMENT FOR OUTPATIENT THERAPY PROVIDED PHYSICAL ( THERAPYASSISTANTS PTA
)
When services are provided by a PTA in whole or
in part with the licensed therapist, Medicare is to create a separate modifier to indicate such instances. When this modifier is used, when billing for services, payment will be reduced to 85% of the fee schedule . The modifier is to be created by January 1, 2019 and will be required on all claims in January 2020 . New payment fee schedule is effective 2022 .
FUNCTIONAL REPORTING REQUIREMENT
The requirement for functional reporting is proposed to be eliminated effective January 2019 . The reporting was originally created to measure the patient's status to align the therapy cap .
MERIT BASED INCENTIVE PAYMENT SYSTEM (MIPS)
The reporting is a consolidation of Medicare's Meaningful Use (MU) program, Physician Quality Reporting System (PQRS), and Value-Based Payment Modifier (VM) program.