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Medicare Physical Therapy Cuts Impact Access to Care

Upcoming Medicare physical therapy cuts could impact patients’ access to care in major ways. The Centers for Medicare & Medicaid Services (CMS) issues a proposal to make changes to the Medicare Physician Fee Scheule (PFS). However, future cuts are something patients and providers alike are against.

Upcoming Medicare Physical Therapy Cuts May Impact Patients’ Access to Care

The proposing rule updates the rates and policies for provider payment. The rule includes updates for other services allowed under the PFS. This is just one of many plans to make for a better care system.

CMS wants to see a better quality of care, affordability, and innovation within the system. The proposal was a buzz within the medical community.

For clarity, the PFS or physician fee schedule rule is a document highlighting the pay rates for individual providers.

The PFS includes a wide range of healthcare settings and providers alike.

The Upcoming Medicare Proposal for Physical Therapy Cuts

Against the opinions of many, CMS plans to carry out its plans. These plans would mandate health care providers to use a more difficult system for billing services in 2022.

Specifically, to show when a patient receives services from either an Occupational or Physical Therapist Assistant. Adding modifiers (CQ and CO) to claims. Here’s where it gets a little more difficult. This system is based on the minutes of the service provided.

A brief summary of treatment must be in the patients’ notes explaining the modifier.

In 2022, pay cuts are 15% when a PTA gives 10% or more of therapy. Which is driving the concern for the delivery of services. For those living in rural parts and areas with little access to care, this is concerning. The upcoming changes may reduce access even further.

One recommendation is that if Medicare finalizes the upcoming physical therapy cuts, providers in rural areas should be exempt from this ruling.

Physical and Occupational Therapy Services

The complications come with the breakdown of therapy services. Therapists, both physical and occupational, know the services aren’t always so simple.

For example, some services have both therapists and therapist assistants throughout the entire duration of care.

In other cases, PTA (or OTA) services may be administrative while some are nontherapeutic. Another concern is the payment breakdown for group therapy.

Responding to these and other possible difficulties, CMS made a few certain decisions. The services that don’t require training but are given by either a PTA or OTA – these services don’t count.

CMS gives examples of how to determine the time of service in different situations.

A Letter to CMS Describes the Plan as “Fundamentally Flawed”

To say the organization disagrees with upcoming proposals is an understatement. The organization continues its fight for a less complicated and more patient-friendly system.

It’s a threat to patient access and a nightmare; it goes completely against CMS’ “patients over paperwork” initiative to ease provider burdens.

PT cuts would add extra work for some providers. Not all therapists run a large staff company. Smaller companies may not have the administration for billing and coding.

However, many are in agreeance that the changes are a “bad idea”. Suggesting the changes may drive a wedge in the community of therapy providers enrolled in the program.

The letter to CMS adds six more reasons supporting why these new documentation requirements aren’t a good idea. Including how it goes beyond the administrative contractor requirements; it also adds difficulty to the 15-minute timed billing.

Another key argument is how this ruling would apply a standard for therapists and assistants; yet, this isn’t the standard for physicians, nurse practitioners, and physician assistants.

What to Expect from Upcoming Medicare Physical Therapy Cuts

CMS will receive 2 comment letters on the proposed fee schedule rule from the APTA in the upcoming weeks. Several provider associations will meet with CMS officials sometime in September to present their cause for concern and give advice.

This is important, as the future of physical therapy assistants is at stake. Like a ripple effect, fewer assistants put more burden on the provider and then the patient’s quality of care suffers.

Therapists often claim the assistants they work with are essential; they’re a team and feel their fee for service shouldn’t be cut.

For those in the profession working in rural areas, patients often make up half of their patients. Upcoming physical therapy reimbursement cuts may reduce patient care access significantly.

If you want to voice your opinion, now is the time to do it. Visit the “Regulatory Take Action” website and fill out the template letter.

The proposal is just that; opinions, comments, and advice from the public. Between the providers and the public, it may impact CMS’ official decision.

Don’t forget to check out our article on all the changes in Medicare.

Lindsay Engle

Lindsay Engle is the Medicare expert for MedicareFAQ. She has been working in the Medicare industry since 2017. She is featured in many publications as well as writes regularly for other expert columns regarding Medicare. You can also find her over on our Medicare Channel on YouTube as well as contributing to our Medicare Community on Facebook.


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