2013 the year of change
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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
slide5
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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