{"id":5948,"date":"2018-01-01T14:47:29","date_gmt":"2018-01-01T19:47:29","guid":{"rendered":"https:\/\/systems4pt.com\/staging\/?p=5948"},"modified":"2018-05-04T08:59:13","modified_gmt":"2018-05-04T12:59:13","slug":"medicare-payment-reduction-didnt-hear","status":"publish","type":"post","link":"https:\/\/systems4pt.com\/staging\/medicare-payment-reduction-didnt-hear\/","title":{"rendered":"New KX exceptions and Medicare Payment Reductions You Didn\u2019t Hear About"},"content":{"rendered":"

<\/div><\/div>

KX exceptions and Medicare Payment Reductions You Didn\u2019t Hear About<\/h2>\n

Last Friday we heard about three changes:<\/u><\/strong><\/h2>\n
    \n
  1. The KX exception (for use when treatment above the $2,010 cap can be defended) has been continued, indefinitely.<\/li>\n
  2. The $3,600 Medicare \u201cThreshold\u201d has been reduced to $3,000.<\/li>\n
  3. In 2022, CMS will lower PTA and COTA reimbursements by 15%.<\/li>\n<\/ol>\n

    Beyond these high-profile changes, something else is new:<\/p>\n<\/div>

    The Medicare Payment Reduction You Didn\u2019t Hear About<\/b><\/u><\/h2>\n<\/div>

    For treatments as of January 1, 2018, Medicare has lowered reimbursements on some of the most widely-used CPT codes in outpatient rehab.<\/h3>\n

    Offsetting these reductions, reimbursements for\u00a0five other CPT codes have been increased.\u00a0 (Refer to your MAC\u2019s fee schedule for details).<\/h3>\n<\/div><\/div><\/div>

    Cut<\/h3>\n<\/div>

    Therapeutic Exercise (97110) – 5% cut
    \nManual Therapy (97140) – 6.6% cut
    \nAquatic\u00a0Therapy (97113) – 9% cut<\/p>\n<\/div><\/div><\/div>

    Increased<\/h3>\n<\/div>

    Massage (97124) – 19.3% increase
    \nTherapeutic Activities (97530) – 17.3% increase
    \nElectrical Stimulation (G0283) – 8.9% increase
    \nUltrasound (97035) – 6.5% increase
    \nNeuromuscular Re-education (97112) – 3.7% increase<\/p>\n<\/div><\/div><\/div>

    If you are a typical practice that charges Medicare \u201c2 Ther-Ex, 1 Manual and 1 E*Stim\u201d,
    \non average you\u2019ll suffer a 3.7% pay cut.\u00a0 $4.58 lower reimbursements.<\/h3>\n<\/div>
    <\/span><\/div>

    If you typically charge Medicare \u201c1 Ther-Ex, 2 Manual and 1 E*Stim\u201d,
    \nthe average pay cut will be 4.1% pay cut.\u00a0 $5.02 lower reimbursements.<\/h3>\n<\/div>
    <\/span><\/div><\/div><\/div>

    Reviewing changes to Medicare\u2019s fee schedule on a graph may shed insight into how to offset lower fees.\u00a0 Blue columns are 2017 reimbursement rates, Orange are 2018.\u00a0 Notice Therapeutic Activities vs. Ther-Ex.\u00a0\u00a0 As CMS is apparently placing a higher value on activity-based \/ function-oriented care, many practice owners are reconsidering their approach to treatment.\u00a0 Example, rather than increasing shoulder\/arm strength and ROM with Ther-Ex, some practices are further enhancing treatment toward restoring the reported functional deficit, (ex. lifting\/carrying items)and as such, legitimately charge for Therapeutic Activities.\u00a0 Orienting the treatment plan more precisely toward restoration of the identified deficit (and thoroughly defending it as such in your documentation) results in a more function-based treatment plan as well as higher reimbursements.<\/p>\n<\/div>

    <\/span><\/div>

    Our industry is fluid.\u00a0 As the pace of change accelerates:<\/h3>\n
      \n
    1. Keep aware of changes<\/li>\n
    2. Be open to new approaches (don\u2019t get stuck in yesterday\u2019s approaches)<\/li>\n
    3. Innovate new ways to orient treatment more and more toward functional restoration<\/li>\n
    4. Superior patient\u00a0 progression combined with higher reimbursements are a win-win<\/li>\n<\/ol>\n<\/div><\/div><\/div>
      <\/div><\/div><\/div><\/div><\/p>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":5975,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"content-type":"","footnotes":""},"categories":[56],"tags":[],"class_list":["post-5948","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-general"],"yoast_head":"\nKX exceptions and Medicare Payment Reductions - Systems 4PT<\/title>\n<meta name=\"description\" content=\"KX exceptions and Medicare Payment Reductions You Didn\u2019t Hear About Last Friday we heard about three changes:The KX exception (for use when treatment above the $2,010 cap can be defended) has been continued, indefinitely.\" \/>\n<meta name=\"robots\" content=\"noindex, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"New KX exceptions and Medicare Payment Reductions You Didn\u2019t Hear About\" \/>\n<meta property=\"og:description\" content=\"KX exceptions and Medicare Payment Reductions You Didn\u2019t Hear About Last Friday we heard about three changes:The KX exception (for use when treatment above the $2,010 cap can be defended) has been continued, indefinitely.\" \/>\n<meta property=\"og:url\" content=\"https:\/\/systems4pt.com\/staging\/medicare-payment-reduction-didnt-hear\/\" \/>\n<meta property=\"og:site_name\" content=\"Systems4PT\" \/>\n<meta property=\"article:published_time\" content=\"2018-01-01T19:47:29+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2018-05-04T12:59:13+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/systems4pt.com\/staging\/wp-content\/uploads\/2018\/01\/S4PT_Decline.jpeg\" \/>\n\t<meta property=\"og:image:width\" content=\"2560\" \/>\n\t<meta property=\"og:image:height\" content=\"1707\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/jpeg\" \/>\n<meta name=\"author\" content=\"Systems4PT\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"Systems4PT\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"5 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\/\/systems4pt.com\/staging\/medicare-payment-reduction-didnt-hear\/#article\",\"isPartOf\":{\"@id\":\"https:\/\/systems4pt.com\/staging\/medicare-payment-reduction-didnt-hear\/\"},\"author\":{\"name\":\"Systems4PT\",\"@id\":\"https:\/\/systems4pt.com\/staging\/#\/schema\/person\/cbd6a79a0c6efcdf4bf949f37beca785\"},\"headline\":\"New KX exceptions and Medicare Payment Reductions You Didn\u2019t Hear About\",\"datePublished\":\"2018-01-01T19:47:29+00:00\",\"dateModified\":\"2018-05-04T12:59:13+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\/\/systems4pt.com\/staging\/medicare-payment-reduction-didnt-hear\/\"},\"wordCount\":1010,\"publisher\":{\"@id\":\"https:\/\/systems4pt.com\/staging\/#organization\"},\"image\":{\"@id\":\"https:\/\/systems4pt.com\/staging\/medicare-payment-reduction-didnt-hear\/#primaryimage\"},\"thumbnailUrl\":\"https:\/\/systems4pt.com\/staging\/wp-content\/uploads\/2018\/01\/S4PT_Decline.jpeg\",\"articleSection\":[\"General\"],\"inLanguage\":\"en\"},{\"@type\":\"WebPage\",\"@id\":\"https:\/\/systems4pt.com\/staging\/medicare-payment-reduction-didnt-hear\/\",\"url\":\"https:\/\/systems4pt.com\/staging\/medicare-payment-reduction-didnt-hear\/\",\"name\":\"KX exceptions and Medicare Payment Reductions - 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