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2013 – The Year of Change. How 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

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2013 the year of change

2013 – The Year of Change

How it affects hospital-based rehabilitation


Learning outcomes
LEARNING OUTCOMES

  • Identify new therapy codes

  • Describe new therapy billing requirements


Major issues of change
MAJOR ISSUES OF CHANGE

  • THERAPY CAP/FEE SCHEDULE

  • MPPR (MULTIPLE PROCEDURE PAYMENT REDUCTION)

  • FUNCTIONAL LIMITATION REPORTING

  • PQRS


Therapy cap
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
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 codes mobility walking and moving around
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



Learning outcomes1
LEARNING OUTCOMES

  • Identify new therapy codes

  • Describe new therapy billing requirements


Contact
CONTACT

Joe Sapp

[email protected]

229-315-9291


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