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CMS possibly cutting PT payments by 10%
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CMS possibly cutting PT payments by 10% - September 6, 2006 5:51:00 AM
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Rwantz
Posts: 84
Joined: December 10, 2004
From: Middletown, PA
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I was just reading this on the APTA site. This will surely make it more difficult to make money, but will it really make it more difficult for PTs to treat Medicare patients.
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Re: CMS possibly cutting PT payments by 10% - September 6, 2006 1:58:00 PM
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SJBird55
Posts: 2438
Joined: May 10, 2004
From: Michigan
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We can always choose to be non-participating.
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Re: CMS possibly cutting PT payments by 10% - September 7, 2006 6:37:00 AM
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KIDPT23
Posts: 222
Joined: May 20, 2002
From: Illinois
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yea, try and be non-participating in Medicare and see how many Medicare pt's will pay out of pocket. You may get some, most will not! Medicare is going to cut reimbursements by 10%, eliminate the exception codes, and stop reimbursements on the successful Anodyne infrared treatments. I wonder what they will have on tap next year. The reason for the 10% is really a blow to our profession. They are doing this because of the significant overbilling done by POPTS over the past few years. I feel that this is complete bull****. They overbill and we suffer for it...unbelievable!!!
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Re: CMS possibly cutting PT payments by 10% - September 7, 2006 12:59:00 PM
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SJBird55
Posts: 2438
Joined: May 10, 2004
From: Michigan
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Umm, they are technically reducing the payments by 10% because for 2007 they increased physician codes - I'm not sure exactly which ones, but I believe the eval/management codes. Since they increased the payments for those codes, they needed to create balance and reduce reimbursement for codes somewhere else. What is more of a pisser than the 10% is that they are actually reducing the number calculated in for determining the cost of providing services that takes into consideration our "work." Our "work" hasn't changed, in fact, I believe the system is more complex than it used to be and reducing that unit is ludicrous. I believe it was the RVU that got reduced. I don't believe referral for profit situations had anything to do with the reduction in reimbursement rates.
Technically, Medicare patients WOULD be cut a check by Medicare after a claim was submitted by a provider. Patients would pay up front, providers would be capped in the actual amount that could be charged a Medicare patient (and we would make a more appropriate fee for service dollar amount). I calculated it out and technically, patients would be paying about $12-15 extra for an initial evaluation (I think - I threw out my spreadsheet) and I think about $6-11 more per visit the way I tend to treat. I know that Medicare does pay quite quickly when sending claims electronically with electronic fund tranfers. So, if you billed out Medicare twice per week, patients would receive their payments maybe within 3-4 weeks.
We need to get the mindset that our services are worth paying for... and that medical care isn't free... and it's okay to wait for insurance companies to reimburse patients.
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Re: CMS possibly cutting PT payments by 10% - September 10, 2006 7:12:00 PM
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ptdan23
Posts: 224
Joined: November 6, 2003
From: Orlando, FL
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The whole 10% payment reduction by CMS would hit a lot of practices hard. I am hoping that it does not go through - will have to wait and see. Make sure that you write to your legislators and let them know your concerns. I do agree with SJ in her point about that our services are worth paying for. We need to charge an appropriate amount for what we do and make sure that we get paid for it. If we do not do this we cannot stay in business. If this happens how can we take care of the patients that we care so much about?
Dan, PT.
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Re: CMS possibly cutting PT payments by 10% - September 11, 2006 11:00:00 AM
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KIDPT23
Posts: 222
Joined: May 20, 2002
From: Illinois
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Yea that would be great if we could bill out a medicare patient 100-150 dollars a session knowing that we will be reimbursed lets say only 40 and the secondary pays 20 and we charge the patient the remainder, however we can't so we are at the mercy of what medicare deems reasonable to reimburse us. At this rate we will be reimbursed 25 dollars in 10 years or so. Frustrating!!!
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Re: CMS possibly cutting PT payments by 10% - September 12, 2006 8:49:00 AM
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KIDPT23
Posts: 222
Joined: May 20, 2002
From: Illinois
Status: offline
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The 10% is actually from the proposed changes in work values and practice expense values that may be implemented at the same time the fee schedule conversion factor is cut. The reason for the increase (which is 37%) of the work values due to evaluation and management codes billed by physicians. This includes incidence to billing and because the law requires that adjustments be budget neutral, work values for all increases by 10%(6% for physical therapy and the 4.6% conversion factor).
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Re: CMS possibly cutting PT payments by 10% - September 12, 2006 1:14:00 PM
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SJBird55
Posts: 2438
Joined: May 10, 2004
From: Michigan
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Not sure where you read about the conversion factor being changed... what I read said that the work values were being reduced with a 10 year plan or something to increase the practice expense values. If you look at the Medicare fee schedule, you will see that the formula is multiplying a bunch of numbers to get the final reimbursed amount. The work value is just one number in the calculation. Technically, the conversion factor could be changed and I wouldn't be as upset, but the proposed change is decreasing the work value.
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