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2013 – The Year of Change How it affects hospital-based rehabilitation.

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Presentation on theme: "2013 – The Year of Change How it affects hospital-based rehabilitation."— Presentation transcript:

1 2013 – The Year of Change How it affects hospital-based rehabilitation

2 LEARNING OUTCOMES Identify new therapy codes Describe new therapy billing requirements

3 MAJOR ISSUES OF CHANGE THERAPY CAP/FEE SCHEDULE MPPR (MULTIPLE PROCEDURE PAYMENT REDUCTION) FUNCTIONAL LIMITATION REPORTING PQRS

4 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

5 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

6 FUNCTIONAL LIMITATION REPORTING NON-PAYABLE G CODES WILL BE ASSIGNED AT INITIAL EVALUATION, EACH 10 TH 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

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8 EXAMPLE OF G CODES MOBILITY: 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

9 EXAMPLES OF MODIFIERS MODIFIERIMPAIRMENT LIMITATION RESTRICTION CH0 PERCENT IMPAIRED CI1-20 % IMPAIRED CJ20-40% IMPAIRED CK40-60% IMPAIRED CL60-80% IMPAIRED CM80-100% IMPAIRED CN100% IMPAIRED

10 LEARNING OUTCOMES Identify new therapy codes Describe new therapy billing requirements

11 CONTACT Joe Sapp


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