According to Kaiser Health News, 30% of Medicare participants could see their Part B monthly premiums increase in January 2016 by 52% ($104.90 to $159.30). New enrollees, current participants with incomes greater than $85,000, beneficiaries who pay their premiums directly (instead of an automatic deduction from social security) and dual eligibles (beneficiaries elegible for both Medicare and Medicaid) make up the 30% facing the rate hike. Learn more
CMS released proposed rules for 2016 for the Physician Fee Schedule
The payment rate for physical therapy services is estimated to increase approximately 0.5%. Hospitals will receive .9% increase, which is lower than the originally proposed 1.1% increase.
Potential Reimbursement Reductions
Ten CPT codes therapists typically report were identified by CMS for review to determine if they are "misvalued." The decision to recalculate the values is based on proposed changes in the physician work and direct practice expense components of the codes. These codes haven't been reviewed since 2009 or earlier, and are in the group of 118 total "high expenditure" codes (with Medicare allowed charges of $10 million or more) identified for review. CMS has set a goal for a 1% reduction in expenditures for “misvalued” codes in 2016.
The codes are 97032 (electrical stimulation), 97035 (ultrasound therapy), 97110 (therapeutic exercises), 97112 (neuromuscular reeducation), 97113 (aquatic therapy), 97116 (gait training), 97140 (manual therapy), 97530 (therapeutic activities), 97535 (self-care management training), G0283 (electrical stimulation other than wound).
PQRS
Therapy PQRS requirements and measures under PQRS are not expected to change in 2016. Eligible therapy providers who don't successfully participate in PQRS in 2016 will face a 2.0% reduction in payment in 2018. Non-participation will affect reimbursement under the value-based reimbursement expected to apply to therapy practitioners in 2017.
Therapy practioners are not part of the value-based modifier program in 2016, although the program will expand to a limited group of other eligible nonphysician professionals.
Public comments on the proposed rules are due by September 8, 2015, and the final rule will be published in November of 2015. Learn more
