2013 – The Year of Change

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 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

8. 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

9. EXAMPLES OF MODIFIERS

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

11. CONTACT Joe Sapp Joe@itcmgt.net 229-315-9291