2021 Medicare Changes for Physical Therapists, Speech Language Therapists, and Occupational Therapists

Recently the Centre for Medicare and Medicaid Services (CMS) came out with select changes in the fee schedule for the Physical Therapists, Occupational Therapists, and Speech-Language Pathologists. One of the major rulings under the 2021 Medicare Physician Fee Schedule (MPFS), implements a 9 % decrease in the reimbursement fee for PT, OT, and SLP services. This rule has been made effective since January 2021.

2021 Medicare Changes for Physical Therapists, Speech Language Therapists, and Occupational Therapists

This comes at a time when medical health service providers expected to find relief from the difficulties arising out of COVID 19. Many practices and institution-based healthcare providers are already cutting out their staff or closing down their services because of the COVID 19 ramifications. A further cut in the fee reimbursements can put more pressure on the therapists.

CMS has announced this ruling as part of its measure to achieve budget-neutrality. CMS has revalued the rates of several Evaluation and Management Codes (E&M) giving raise to primary specialties and reducing the amount paid to more than thirty specialties including PT, OT, and SLP.

The ruling has more changes that also bring a ray of hope, spurring a debate whether the total impact of this goes in favor or proves detrimental for the industry.

What are the key changes:

• CMS has decided to acknowledge PT, OT, and SLP evaluation services as similar to E/M codes. Earlier the therapists seldom billed for these codes but now this will ensure a modest raise in the reimbursements.
• MS plans not to extend permanent telehealth privileges to PTs, OTs, and SLPs. However, PTs, OTs, and SLPs will be allowed to provide brief online assessment and management services as well as virtual check-ins and remote evaluation services, and this new code is proposed to be created by the CMS.
• CMS has allowed PTAs (Physical Therapy Assistants) and OTAs (Occupational Therapy Assistants) to provide maintenance therapy to Medicare beneficiaries if deemed clinically appropriate.
• CMS has also allowed the students to document in the medical record on the condition that it is reviewed, verified, and signed by the billing therapist.
• PTs and OTs will not be able to bill Medicare for remote physiologic monitoring (RPM) codes
• CMS proposes to reduce the proposed 2020 performance threshold to 50 from 60. This means OTs will be required to achieve a score of at least 50 points to avoid a penalty in 2021,
• CMS has indicated that they will be moving forward with the MIPS Value Pathways (MVPs) model discussed in the 2020 final rule, but the initial proposal will be delayed until the 2022 performance year.
• Two additional dementia measures have been proposed to be added to the therapy specialty set, which is appropriate for reporting by OTs.

The medical fraternity must wait and get prepared to fight this battle in ensuring rewarding reimbursement for our services. H.R. 8702 is bipartisan legislation that will address these cuts by providing relief payments in an amount that will ensure parity with current payments for impacted services. Professional medical billing services companies can help you decode the new rules and leverage them to your benefit.

Atlantic RCM is one of the leading multi-specialty medical billing companies in USA that serves 25+ major medical billing specialties. Our experts work across your practice in billing, collections and account receivables management, to help you succeed.

Get in touch with the leading medical billing outsourcing company to learn more. Call us at (469) 501-1500 or write to us Info@atlanticrcm.com