The final 2014 Medicare physician fee schedule rule released by the Centers for Medicare and Medicaid Services (CMS) sets the therapy cap amount on outpatient services at $1,920. In addition, the rule announces a 20.1% reduction in Medicare payment rates for OTs and PTs, physicians, and other health care professionals -- a cut linked to the flawed sustainable growth rate (SGR) formula being discussed in Congress.
The 20.1% reduction in the final rule is the conversion factor used to determine Medicare payment rates, a reduction generated by the flawed SGR formula. Since 2003, Congress has enacted legislation preventing the reduction every year. The president's budget calls for averting these cuts and finding a permanent solution to this problem. Congress is currently working to address an alternative payment method that would include permanent repeal of the SGR.
If Congress does stop the 20.1% payment cut, the aggregate payment for outpatient physical therapy services due to changes in practice expense, work and malpractice relative value units would remain unchanged from 2013. Aside from setting the therapy cap at $1,920 for 2014, the rule makes changes to payments to critical access hospitals (CAHs) beginning January 1, 2014. The therapy cap automatic exceptions process and the manual medical review process applicable to outpatient therapy expenditures exceeding $3,700 per beneficiary, will expire on December 31, 2013 unless Congress acts to extend them.
Contact your members of Congress today and tell them to support the Medicare Access to Rehabilitation Services Act (HR 713/S 367). If this act does not pass by the end of the year, a therapy cap will again be imposed on Medicare-covered therapy services and will limit access to important rehabilitative services.
Contact your Representative
Contact your Senator
Questions? Email ASHT@asht.org
ASHT Legislation & Reimbursement Division
