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]

Heidi-

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

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

particular.

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

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

Medicare put into place Jan 1. Medicare

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

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

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

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

Medicare rate.

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

starting in January.

Marcy Stalvey, PT, NCS

Kent, OH

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

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]

Many issues are interesting from Mark's original question.

Mark, Medicare did indeed institute the MPPR (Multiple Procedure Payment

Reduction) policy in January 2011. If multiple codes are billed on one date of

service by PT, OT, and SLP then the code with the highest practice expense

component is paid at 100% of the outpatient Medicare Physician Fee Schedule

(MPFS) amount, but all subsequent codes from all disciplines billed on that date

are paid at a reduced amount. That reduced amount is calculated by reducing the

practice expense component of the fee schedule payment by 20% in private

practices and physician owned practices and by 25% in institutional settings

(e.g., hospital-based clinics). I've seen estimates that the NET payment

reduction that we will see is anywhere between 4% and 10% depending on which

codes are billed and what their practice expense components are. APTA has a

good summary of the MPPR on their website so I recommend going there for much

more information about this.

As to the Blue Cross issues that others have mentioned, we've seen a lot in

Kansas this past year. Blue Cross Blue Shield of Kansas (BCBSKS) instituted a

policy in October 2010 whereby PTA supervision mirrored what is required in

Medicare PTPPs with the PT having to be in the clinic. PTAs were also required

to secure NPI numbers. That prepped for the other policy, which was instituted

in January 2011 whereby services provided by PTAs are paid at 50% of the

Maximium Allowable Payment (MAP), which is BCBSKS' fee schedule. Also, PTs,

along with OTs, SLPs, NPs, PAs, DCs, etc. were reduced from 90% of the MAP to

85% of the MAP.

We just learned that Blue Cross Blue Shield of Kansas City (BCBSKC) instituted

on January 1, 2011 a new policy where they are essentially following the

Medicare MPPR policy. This is new and clinics are still gathering information

on this change, but it appears that it has been instituted at the 25% reduction

level. APTA has been notified of this and at first clinics were being told that

this change was happening in multiple BCBS plans around the country, but APTA

has not found any other BCBS plan instituting it, so it appears to be isolated

to BCBSKC only. From what I have heard in the community clinics are still

talking with BCBSKC to get more information about how it is being implemented

and whether there are any contractual issues with it.

Mark Dwyer, PT, MHA

Olathe, KS

>

> 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.

>

>

>

>

>

> 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

in

> 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

BC.

> 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

definetly

> 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

[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

[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