Re: step down Medicare payment

[Guest guest]

Yes, we noticed changed at the first of the year. It was not alot but definetly

a hit. BCBS of KC was our biggest hit with the tier payments. When billing 4

units of something it took us down by approx $30.00 per hour! They say the are

following Medicare with the tier payments so I don't understand why Medicare

change was approx $9 per hour when billing 4 units and theirs $30.00. It hit

very hard for a private practice.....

Heidi

Billing Manager

MO

Physician relations

Need some advice and a listening ear...

I have a physician that is being very " doctorish " over PT communicating with

im regarding patient progress. He is the only physician that has this problem.

He is wanting bi-weekly communication of how his patient's are progressing

hile in the hospital. he is adamant about not reading PT notes or learning any

PT " oriented abbreviations i.e. min assist, CGA, etc.

He now wants PT to document on a seperate sheet on patient progression.

Needleess to say I am frustrated by his stance and obstinance.

any suggestions, ideas or previous experience with similar matters is

ppreciated.

Gwilliam, PT, CWS

Director of Rehabiliation

Bowie Memorial Hospital

[Guest guest]

No this is not related to PTA's. I know that is happening in Kansas but we are

are MO. I called our provider rep and she said this took effect 1/13/2011. She

said they are following Medicare with the tier payment and no, we did not get a

new contract nor did we sign one. She said it is what they were always supposed

to be doing (following Medicare guideline and fee structure) but did not put it

into effect until 1/13. It has been enough to shut a practice down if your used

to billing one hour of PT using 4 units of the same code.

Physician relations

Need some advice and a listening ear...

I have a physician that is being very " doctorish " over PT communicating with

m regarding patient progress. He is the only physician that has this problem.

He is wanting bi-weekly communication of how his patient's are progressing

ile in the hospital. he is adamant about not reading PT notes or learning any

T " oriented abbreviations i.e. min assist, CGA, etc.

He now wants PT to document on a seperate sheet on patient progression.

Needleess to say I am frustrated by his stance and obstinance.

any suggestions, ideas or previous experience with similar matters is

preciated.

Gwilliam, PT, CWS

Director of Rehabiliation

Bowie Memorial Hospital

[Guest guest]

Mark,

If you could keep me or the list informed of your info regarding APTA and

BCBSKC. This was a cut to us of over $20 per hour. When that is added up, for

us, it is a few salaries to make up for. Our provider rep, Reginna McGinnis,

just said this is something they were supposed to be doing all along, and it was

in the contract that they follow Medicare guideline. My question is why is

Medicare's allowable's much higher than BCBSKC now? Why was the cut we took from

Medicare less than half of what we took from BCBSKS? Does not seem to make much

sense to me. Now, BCBSKC is about the lowest reimbursement contract we have when

they were the highest. At 45% of our business, it hit hard. Would love to stay

informed on APTA's actions about this. Thanks!

Heidi Harmon

Billing Manager

Re: step down Medicare payment

Heidi-

Are you also noticing that services provided by PTAs are being paid at a

educed rate from the PT's? We have heard this was happening with BC Kansas

n

articular.

ow do you think this might affect patient access to your services?

You may also be seeing the effects of the multiple procedure reduction that

edicare put into place Jan 1. Medicare

I do have a general question for those of you who have signed contracts with

C.

id they do this without a change in your contract? It seems that they would

ave to give you reasonable notice that this would be occurring ( and so giuve

> ou the option to opt out) unless your contract is tied directly to the

edicare rate.

Just FYI- The NPs and PAs were also affected by tiered payments in Kansas

tarting in January.

Marcy Stalvey, PT, NCS

ent, OH

>> Heidi Harmon 2/22/2011 9:41 AM >>>

Yes, we noticed changed at the first of the year. It was not alot but

efinetly

hit. BCBS of KC was our biggest hit with the tier payments. When billing 4

nits of something it took us down by approx $30.00 per hour! They say the are

ollowing Medicare with the tier payments so I don't understand why Medicare

hange was approx $9 per hour when billing 4 units and theirs $30.00. It hit

ery hard for a private practice.....

Heidi

illing Manager

O

----Original Message-----

rom: Mark Niles

o: PTManager

ent: Tue, Feb 22, 2011 7:53 am

ubject: step down Medicare payment

roup,

as anyone heard or encountered step down or tiered pymnt for Medicare this

ar? Step down pymnt for each unit of a charge. Did I miss a change somewhere?

ark Niles PT, MS, CSCS

thopedic Specialists PA

iles@...

4-720-7448 x3

4-720-9042 fax

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[Guest guest]

I think what you are seeing is a result of the new Medicare Multiple Procedure

Payment Reduction implementation. Please see below for the excerpt from the

First Coast site:

" Multiple procedure payment reduction for selected therapy services

Effective date: January 1, 2011

Implementation date: January 3, 2011

Summary

Section 3134 of The Affordable Care Act added section 1848©(2)(K) of the

Social Security Act, which specifies that the Secretary of Health & Human

Services shall identify potentially misvalued codes by examining multiple codes

that are frequently billed in conjunction with furnishing a single service. As a

step in implementing this provision, Medicare is applying a new multiple

procedure payment reduction (MPPR) to the practice expense component of payment

of select therapy services paid under the Medicare physician fee schedule

(MPFS). The reduction will be similar to that currently applied to multiple

surgical procedures and to diagnostic imaging procedures. This policy is

discussed in the calendar year (CY) 2011 MPFS final rule.

Many therapy services are time-based codes, i.e., multiple units may be billed

for a single procedure. The Centers for Medicare & Medicaid Services (CMS) is

applying a MPPR to the practice expense payment when more than one unit or

procedure is provided to the same patient on the same day, i.e., the MPPR

applies to multiple units as well as multiple procedures. Full payment is made

for the unit or procedure with the highest practice expense payment. For

subsequent units and procedures, furnished to the same patient on the same day,

full payment is made for work and malpractice, and 75 percent payment for the

practice expense.

Here is the link to the MLN Matters article

MM7050<http://www.cms.gov/MLNMattersArticles/downloads/mm7050.pdf>

[cid:image001.jpg@...] . "

Natasha Forbes-Thorne, OTR, MBA/HCM

Rehab Director

Florida Hospital Zephyrhills

7050 Gall Blvd., Zephyrhills. FL 33541

From: PTManager [mailto:PTManager ] On Behalf Of

Heidi Harmon

Sent: Tuesday, February 22, 2011 9:42 AM

To: PTManager

Subject: Re: step down Medicare payment

Yes, we noticed changed at the first of the year. It was not alot but definetly

a hit. BCBS of KC was our biggest hit with the tier payments. When billing 4

units of something it took us down by approx $30.00 per hour! They say the are

following Medicare with the tier payments so I don't understand why Medicare

change was approx $9 per hour when billing 4 units and theirs $30.00. It hit

very hard for a private practice.....

Heidi

Billing Manager

MO

Physician relations

Need some advice and a listening ear...

I have a physician that is being very " doctorish " over PT communicating with

im regarding patient progress. He is the only physician that has this problem.

He is wanting bi-weekly communication of how his patient's are progressing

hile in the hospital. he is adamant about not reading PT notes or learning any

PT " oriented abbreviations i.e. min assist, CGA, etc.

He now wants PT to document on a seperate sheet on patient progression.

Needleess to say I am frustrated by his stance and obstinance.

any suggestions, ideas or previous experience with similar matters is

ppreciated.

Gwilliam, PT, CWS

Director of Rehabiliation

Bowie Memorial Hospital