PTPN comments to CMS on physician referral, FLR, PTAs, MIPS

In August, PTPN submitted comments to CMS on a variety of topics important to therapists. Here are the highlights.

 

MEDICARE FEE SCHEDULE PROPOSALS

PTPN applauded CMS for proposing to repeal Functional Limitation Reporting! Capturing this data is time consuming, time better spent on patient care, especially since the data is both flawed and wasn’t used by CMS. We also supported separating physical and speech therapy when calculating thresholds for therapy utilization.

We voiced our concerns about the proposed modifier for PTA and OTA services. In 2022, CMS is going to pay for services provided by assistants at 85% of what they pay for services provided by therapists. In 2019, they want therapists to start using a new modifier to identify these services. CMS is proposing to include services that need the modifier (and thus get paid less) where any minute of outpatient therapy service that is therapeutic nature is provided by the therapy assistant. We proposed that only services which are provided solely by the assistant should require a modifier.

 

QUALITY PAYMENT PROGRAM PROPOSALS

If you aren’t aware of it by now, you will be soon. CMS is proposing, and likely will be, including physical and occupational therapy in 2019 in the Quality Payment Program (QPP).

We supported CMS in maintaining the low-volume exemption, since many small private practice PTs and OTs will fall below the threshold triggering an obligation to participate in MIPS (which is the “PQRS-like-plus” part of the QPP). The low-volume threshold is less than 200 patients, OR less than $90,000 in allowed charges, per therapist or per group — the provider gets to pick.

We were very pleased that CMS is proposing not to include physical and occupational therapy in the Promoting Interoperability Category of MIPS, which means that therapists get a “free pass” from being required to have a Certified EHR. Since PTs and OTs have not received any financial incentives or support for implementing the Certified EHR from CMS, it would be inappropriate to require it in MIPS participation.

As first-year participants in the QPP, we requested that PTs and OTs be allowed to “ramp up” in terms of what level of reporting is required in order to meet a threshold which will allow them to be eligible for positive payment adjustments, just like the physicians did when they started out.

 

PHYSICIAN SELF-REFERRAL

CMS requested information about issues surrounding physician self-referral. As always, our comments centered around not allowing physicians to self-refer when it comes to therapy services, and if they are allowed to do so, it should be transparent to the patient that the doctor has a financial interest in the therapy services, and it should be clear to the patient that they can go elsewhere for treatment.

 
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