Category: News

The 2024 Physician Fee Schedule Proposed Rule includes yet another cut to Medicare reimbursements for physical therapy services.

Proposed Medicare Cuts and What You Can Do About Them

The Centers for Medicaid and Medicare Services (CMS) issued the 2024 Physician Fee Schedule (PFS) proposed rule on July 13, 2023. The proposed changes include a 3.3% cut to the conversion factor — yet another cut to physical therapy reimbursements. The current conversion factor is already lower than in 1994, when the U.S. dollar held 52% more value (before decades of inflation).  

CMS is accepting public comments on proposed policy changes until September 11, 2023. If approved, the changes will take effect on or after January 1, 2024. 

To get a better understanding of what’s in the 2024 Physician Fee Schedule proposed rule, Chad Madden spoke with Mary Daulong, President and CEO of BCMS. Mary shares the biggest takeaways from the Proposed Rule. Together, they discuss what practice owners can do to maintain profitability.

This article summarizes what we learned. Continue reading for expert insights into the proposed policy changes and practical steps you can take to navigate Medicare Cuts.

TABLE OF CONTENTS

Understanding the 2024 Physician Fee Schedule Proposed Rule

How to Submit Comments on the Proposed Rule

How to Survive Medicare Cuts in the 2024 Physician Fee Schedule

Maintaining Profitability Under Pressure

Understanding the 2024 Proposed Physician Fee Schedule

The 2024 Physician Fee Schedule includes another cut to the conversion factor, and policy changes to telehealth services, caregiver training and codes, the KX modifier threshold, the supervision policy, and more. 

Readers are encouraged to participate in the comment process and advocate for changes that benefit your practice and your patients. 

While the proposed reimbursement cuts pose challenges, there are steps you can take to maintain profitability and continue providing high-quality care to your community. 

Let’s take a look at the major updates in the 2024 Physician Fee Schedule.

Conversion Factor

The primary concern in the proposed rule is the 3.34% reduction in the conversion factor compared to 2023. The proposed 2024 conversion factor is $32.75, a decrease of $1.14. This cut to the conversion factor represents the fourth consecutive year of cuts. Congressional funding for 2024 is projected to offset the reduction by 1.25%, which is less generous than the previous year. With congressional funding factored in, the expected reduction is 2.09% from the 2023 conversion factor. 

Supervision of Physical Therapist Assistants 

Since 2005, CMS has required PTs in private practices to conduct direct supervision of PTAs. CMS is soliciting comments on whether they should change the direct supervision requirement for outpatient therapists when working with therapy assistants to general supervision. They are particularly interested in aspects such as quality of care, patient safety, and utilization changes. Advocating for improved patient access to services and stable outcomes can be key points in your comments.

CMS is also proposing a regulatory change to allow for general supervision of PTAs for remote therapeutic monitoring (RTM) services. 

Expansion of Telehealth Services

The proposed rule expands the definition of telehealth practitioners to include physical therapists, occupational therapists, and speech and language pathologists. This extension can be beneficial as it maintains the non-facility rate for reimbursement, which is generally higher for physical therapy services.

Telehealth Supervision

CMS is also seeking comments on whether they should extend the definition of direct supervision in telehealth. Focusing on quality, patient safety, and access to care can be powerful points to make in your comments.

Caregiver Training and Education Codes

CMS has introduced three new codes for caregiver training and education, which can be utilized by therapists when it’s part of a patient’s care plan. These codes aim to educate caregivers in assisting patients with specific diseases and illnesses, emphasizing the importance of the patient’s functional performance. This aligns with a recent Biden-Harris Administration Executive Order on Increasing Access to High Quality Care and Supporting Caregivers. If finalized, it would help support care for persons with Medicare by better training caregivers.   

Undervalued CPT Codes

In early 2023, the APTA argued to CMS that 19 different codes, including therapeutic exercises, neuromuscular reeducation, gait training, and therapeutic activities, were undervalued by the AMA Relative Value Scale Update Committee that sets payment rates typically adopted by CMS. These codes were simultaneously subject to reductions associated with the Multiple Procedure Payment Reduction (MPPR) system. APTA argued that discounting the codes twice was unacceptable. 

In the proposed rule, CMS directs the AMA committee to review its earlier recommendations. If the recommendation proposed by APTA is adopted, the value of the codes on the list could increase.

The full list of codes affected can be found on page 66 of the proposed rule. When commenting, be sure to advocate for the APTA’s recommended increases to the value of these codes. 

KX Modifier Threshold and Targeted Medical Review Threshold

The KX modifier threshold for PT and Speech has increased to $2,330. This is a $100 increase over 2023. The targeted medical review threshold is $3,000 and will remain so at least through 2028. 

Provider Enrollment

CMS is proposing several regulatory provisions regarding Medicare and Medicaid provider enrollment. The most important of these is a proposed requirement to report additions, deletions, and changes to practice locations within 30 days. 

How to Submit Comments on the 2o24 Physician Fee Schedule Proposed Rule

It’s crucial to participate in the process by providing comments on the proposed rule. Comments are due by September 11, 2023 so don’t miss this opportunity to make your voice heard. APTA’s comment submission tool includes templates to make commenting easier and more effective. Submit your comments at https://regulations.gov/. 

How to Survive Medicare Cuts in the 2024 Physician Fee Schedule

Practice owners cannot afford to be complacent in this challenging environment. To survive years of cuts, it’s critical to take strategic actions in your practice to hedge against declining reimbursements. 

The key is to identify ways you can increase revenue and improve profitability. Those who do nothing are taking on major financial risk. Unfortunately, most practices won’t take action. Those who take strategic actions have an opportunity to reduce financial risk and stand out from the crowd.

So what you can do to successfully navigate Medicare Cuts?

The Profitability Checklist

Chad Madden and Breakthrough developed a profitability checklist based on expert advice and proven strategies.

Here are some key steps to take to increase your practice profitability:

  1. Increase Utilization: Focus on filling up your schedules and optimizing your clinic space to increase patient flow and revenue.
  2. Insurance Contract Review: Assess your insurance contracts. Negotiate rates – see one practice owner’s success negotiating a 10% YOY increase from his biggest payer for three years. Consider dropping your lowest payer. Identify ways to attract more patients covered by your best payers.
  3. Increase Lifetime Patient Value: Lifetime Patient Value represents the total revenue generated by a single patient over their lifetime of their journey with your practice. Explore opportunities to boost lifetime patient value by adding cash pay services, reactivating past patients, and sourcing patient referrals.
  4. Get Consistent with Marketing: In order to maintain full schedules consistently, year-round, it’s essential to consistently implement effective marketing. Consistency is the key. Focus your marketing on strategies to reactivate past patients and attracting better-paying patients.

Want to learn how you can successfully renegotiate reimbursement rates? Get Your Free Copy of the Insurance Renegotiation Template. 

Frustrated with declining physical therapy reimbursement rates? Discover effective strategies for negotiating reimbursement rates.

Maintaining Profitability Under Pressure

Despite the challenges posed by proposed Medicare cuts, you can proactively manage your practice’s profitability. By implementing the strategies outlined in the profitability checklist, you’ll be better equipped to navigate the challenging landscape for private practice owners. 

Remember that profitability is not solely dependent on reimbursement rates but also on your ability to stay agile, adapt, innovate, and optimize various aspects of your practice. By focusing on increasing utilization, reviewing insurance contracts, increasing lifetime patient value, and optimizing your marketing, you can position your practice for success in 2024 and beyond.

Still unsure how you’ll navigate your practice through the proposed changes in the 2024 Physician Fee Schedule? 

Chad Madden spent decades of his career and hundreds of thousands of dollars to discover and implement strategies to help navigate the constantly changing healthcare landscape. These exact strategies resulted in a 5X growth in practice value, from $4 million in 2016 to $20.8 million in 2023. Through Breakthrough, Chad has helped hundreds of other practices implement the exact same strategies. 

You can learn more about strategies to help you navigate 2024 Medicare Cuts in a free strategy call with Breakthrough. 

Discover PT profitability strategies for navigating 2024 Medicare Cuts. Book a free strategy call.

We encourage you to utilize the provided resources and take action to protect the future of your practice. Together, we can navigate these challenges to maintain the financial health of your practice so you can continue to provide exceptional care to patients. 

 

Mary Daulong, Founder and CEO of BCMS, discusses the final rule of the 2023 CMS Physician Fee Schedule.

Medicare reimbursement cuts for physical therapists have been finalized for 2023.

On November 01, 2022, the Centers for Medicare & Medicaid Services (CMS) released the final rule for the Medicare Physician Fee Schedule (PFS) and other Medicare Part B issues, effective on or after January 1, 2023. Here’s what we know. 

To help physical therapists and practice owners understand the final cuts to Medicare reimbursements in 2023, we’ve reassembled last year’s panel which discussed the 2022 Medicare Cuts.

Chad Madden, co-founder of Breakthrough, Mary Daulong and Alicia Mahoney—CEO and COO at Business & Clinical Management Services (BCMS)—linked up once more to discuss the 2023 changes to the CMS Physician Fee Schedule. They hosted a live Q&A with hundreds of interested practice owners and therapists. 

When you next have time, we highly recommend checking out the webinar recording. 

A summary of that conversation, including the key things you need to know about next year’s Medicare Cuts, is documented in this article.  

Q: What are the key changes proposed for the 2023 medicare payments?

A: In a nutshell…

  • The CY 2023 fee schedule conversion factor is $33.08, a 4.42% decrease (or $1.53) from the CY 2022—the lowest since the 1990s.
  • The Assistant Payment Differential (APD) is here to stay.
  • Assistant supervision is scheduled to expire at the end of 2022, but Medicare is proposing to extend the ability for therapists to conduct general supervision.
  • Therapists are still not on the permanent list of telehealth suppliers/providers.

Q: How can we minimize revenue reductions caused by the APD?

A: As much as many of us would love for this not to be the case, Assistant Payment Differential (APD) is looking more and more like it’s here to stay. When we look at our neighboring professions, we see how they have been dealing with it in a similar way for years. The good news is, there are actionable steps we can take to minimize revenue reductions caused by APD. These include:

  1. Avoiding co-managing a visit with an assistant. It lessens the administrative burden of counting time, which saves money
  2. Do not use assistants to help with evaluations and re-evaluations, as it will decrease the fee paid by Medicare
  3. Use assistants to perform the objective elements of Progress Reports, as this is not billable to Medicare

Q: Will Assistant Supervision rules be adapted or changed in 2023?

A: As many of you will know, during the pandemic therapists were allowed to conduct ‘general supervision’ of clients and patients which allowed for audio-visual supervision to take place as opposed to direct supervision. General supervision however is scheduled to expire at the end of 2022, although Medicare is proposing that it continues—despite not providing a clear target on the calendar. We will update our community as soon as we have a clearer consensus.  

Q: Are there any changes about who can and cannot provide Telehealth in 2023?

A: Therapists are still not on the permanent list of telehealth suppliers/providers. However, the House has passed the Advancing Telehealth Beyond COVID-19 Act. This bill that would extend the CMS waiver permits for telehealth by therapists until December 31st, 2024, regardless of the status of the Public Health Emergency (PHE). This is a great opportunity to write or call your state representatives and senators to see if they can take this further than 2024. 

Because of the PHE—as mentioned above—there is a temporary public health emergency waiver that allows telehealth to continue through the year that the PHE ends (currently set for 2023) +151 days. After these 151 days, practitioners will be required to use the following updated POS indicators for telehealth services:

  1. POS “02” – This code will be redefined if finalized as Telehealth Provided Other than in Patient’s Home
  2. POS “10” – This code would be redefined if finalized as Telehealth Provided in Patient’s Home

There are still geographical laws and regulations that must be abided by at a state level. For example, if you wish to provide telehealth to a patient in Florida whilst you’re in New York, your practice act must permit you to perform telehealth in both states.  

Q: What are the most common causes of Medicare audits and compliance costs?

A: Being routinely compliant across the board can save your business large amounts of money. This is especially important in today’s climate, as Medicare audits have skyrocketed and many private practices are getting stung simply by being underprepared and unorganized.

For Medicare, the most common audits were Post Payments, Supplemental Medical Review Contractors, and TPE audits. The most common HIPAA violations in 2021 were Illegal Access to PHI, Lack of Security Risk Analysis, and failure to have a Risk Management Process. OSHA violations that tripped up private practices included Failure to Provide Respiratory Protection, effective Hazard Communication, and PPE. 

Q: As practice owners, how do we deal with rising inflation and cuts to Medicare reimbursements?

A: A 4.4% decrease in Medicare reimbursements paired with 8-9% inflation (with a possibility of going higher) will be costly. Practices need to plan for a counteroffensive if they want to stay open and maintain profitability. The good news is, there are lots of tactics one can employ to improve profit margins, save on expenses and survive trying times such as these. You can: 

  • Optimizing staff schedules
  •  Minimize unnecessary overheads (like unused rental space)
  •  Attract patients — new and past patients

Q: What are 3 ways to increase our practice’s topline revenue?

A: In theory, it’s remarkably simple…

  1. Attract new patients
  2. Increase per patient revenue
  3. Reactivate past patients

It’s the execution that is the hard part. 

Breakthrough’s leading Patient Demand Platform makes it easy. Designed specifically for physical thearpy practices, the tool offers pre-built campaigns and automation that generate consistent, predictable revenue growth. 

Click here to schedule a demo.

Q: In our electronic medical records, why can’t both names show on the progress report document, or have a statement describing the exact involvement of the therapist and PTA?

A: Both names can appear on a Progress Report document, but the exact involvement of all parties from a regulatory perspective must be extremely clear so that when Medicare audits you, everything is above board. There must be proof the PTA has not done more than what they are allowed to. This is particularly important to do when you cannot simply eliminate your PTA from signing the report altogether. This doesn’t have to be a complex legal dissertation every time—it could be a previously written succinct statement that’s used universally throughout your clinic.

Q: Will we require an order from an MD in order to be paid from Medicare?

A: No. In short, to be paid by Medicare, your patient’s certified plan of care just needs to be laid out and accepted by their physician. It is always worth double-checking the legislation in your state of practice though. 

Q: How often are progress reports required, and does a Plan of Care certification need to be completed every 90 days? 

A: A progress report is required every 10th visit or less—there is no specific time frame attached to how often this is on a time/calendar basis. Plan of Care certification on the other hand, is on a time basis, and must be re-certified every 90 days

Q: How can we get reimbursed for treatments rendered if a patient self refers and begins the 10 sessions Medicare allows, but doesn’t get sign-off from their physician?

A: It is rare that a patient’s physician doesn’t sign the Plan of Care, as the physician has to comply with Medicare regulations. But in the rare case a patient’s physician doesn’t sign the Plan of Care, a Technical Denial occurs and the financial liability is then passed onto the patient. This is why it is really important to inform the patient that you are operating under a Plan of Care to avoid placing them in this financially vulnerable situation. If the physician still refuses to sign, speak with your patient and let them know that they will need to contact their doctor and request signature for the rest of the Plan of Care to continue under Medicare. 

Still unsure how you will navigate your business through the proposed 2023 medicare cuts? 

With proven tools, tactics, and strategies, the experts at Breakthrough can help you boost your profit margins, streamline your private practice and get you through 2023 and beyond. 

Schedule a call with our team today and we’ll plan your next step together.

During the 2022 PPS event in Denver,  Breakthrough co-founder, Chad Madden, gave a presentation on How to Generate Consistent Patient Demand by Marketing Across All Stages of Awareness. 

In the presentation, Chad revealed how physical therapists could generate consistent demand for their services by marketing across the 5 Stages of Awareness.

Keep reading to learn more about Chad’s session at the event and information on how you can get involved in a national campaign to make PT the first choice for people in pain. 

 

The Current healthcare System is Broken

Right now, the US healthcare system is number one in the world in terms of cost. In 2021, we were spending $12,956 on healthcare per person for a total of $4.3 trillion annually. 

And over the past 40 years, health spending as a percent of GDP has risen dramatically—from 9.9% in 1982 to 13.2% in 1997 to 19.7% in 2021. In comparison, the average health spending as a share of GDP amongst the OECD countries was only 9.5% of GDP. 

The vast majority of US health expenditure goes toward prescription medications, surgeries, and hospital care.

You’d think that with such a steep price tag, the US would have top scores for health in categories like longevity, suicide rates, maternal mortality, and satisfaction.  But the opposite is true:

The US ranks at the bottom of nearly every major health statistic.  

According to Robert H. Schmerling, MD of Harvard Health Publishing, “Our investments in healthcare emphasize technology and specialty care, and we overemphasize procedures and drugs. Our healthcare system is not sustainable.”

Increasing Patient Demand

What’s clear is that this trend is not going to get better on its own. 

As practitioners, we need to do a better job of marketing direct to the consumer and educating patients about the benefits of PT. 

And the most effective way to do this by marketing across all the stages of awareness to increase patient demand for physical therapy.

5 Stages of Awareness

The 5 Stages of Awareness is a marketing  framework first popularized by Eugene Schwartz in his book Breakthrough Advertising.

The basic idea is that it’s no longer enough to simply provide a great service or to have all your marketing talk about how great you are. To succeed in today’s healthcare economy, you need to meet your potential patients where they’re at, in their current frame of mind.

On one end of Schwartz’s spectrum you have the people who are highly Aware of you, your company and your services. They like, know, and trust you already. 

On the other end, you have people who are completely Unaware of you and how you can help them. This is where most of the general population is at when it comes to Physical therapy. They don’t realize that PT can often provide better results than surgery. As a result, far too many patients end up addicted to painkillers or in debt from repeated surgeries that often cause more harm than good. 

Patient Demand is educational marketing and business strategy designed to increase awareness for your practice and conservative care as a whole. It meets people where they are at. Whether they know nothing about PT or they are a current patient, it strategically engages them.

It puts you in the driver’s seat and helps your community better understand why PT is important. The goal is to educate patients about their options and drive more people in your community to PT, rather than surgery, medications, or injections. 

Take the PT Pledge and Increase Demand for PT

At PPS, Breakthrough launched a major industry  initiative: The Physical Therapists’ Pledge.

The pledge includes:

  • A commitment to educating the public about the truth of the US Health System, and the solutions that conservative care provides, 
  • A commitment to building patient demand and putting the choice of care in the hands of the patients themselves.

Once we have 1000 Private Practice clinics in America committed to the pledge, our goal is to a national tv campaign exposing the truth of the US Health System and the solution that Physical Therapy provides. 

We got off to a great start at PPS, with more than 100 signatures. 

Help us hit our goal of 1,000: Visit PatientDemand.com to participate in this National Campaign for a healthcare system that is affordable, accessible, and effective.

2022 medicare reimbursements and guidelines

CMS Releases the 2022 Fee Schedule and Final Rule

Earlier this month, CMS published the final 2022 fee schedule and complete final rule for Medicare payment policies. Chad Madden, Breakthrough co-founder, teamed up with Mary Daulong, President and CEO at Business & Clinical Management Services (BCMS) to discuss the new rules shortly after they were finalized, on a Live Q&A with hundreds of private practice owners and therapists. 

This article summarizes a number of questions and answers that came up around the fee schedules and the new 2022 Medicare rules. We have been inundated by questions on Medicare PTA reimbursements, Medicare PT guidelines, and more upcoming cuts and implications. 

If you’re in the process of planning for the impacts of the 2022 Medicare cuts, check out Breakthrough’s 2022 Planning Tool for Private Practice Owners. As private practice owners, it’s important to regularly assess the financial health of your practice and identify strategies to increase top-line revenue. Use this tool in your annual planning process to develop strategies that will boost profitability in spite of declining reimbursements. 

We held a webinar recently that covered a number of user questions and had a really great turnout. Take a look at the replay below:

Q: What are the key changes in the 2022 fee schedule and final ruling?

A: Here’s the big picture:

  • PTs will see a ~3.7% reduction in payment and OTs will see a ~3.9% reduction in payment.
  • PTAs using the CQ modifier and OTAs using the CO modifier will see a 15% payment reduction
  • PTAs and OTAs may be virtually supervised using A/V communications until 2023.
  • Remote Therapeutic Monitoring (RTM) codes can be billed by physical & occupational therapists, nurses, etc.
  • Therapy KX Modifier Threshold = $2,150 PT/SLP & $2,150 OT.
  • Medical Review Threshold = $,3000. Hitting the threshold does not provoke an audit automatically – they are looking for aberrant billing behavior.
  • MIPS changes Multiple adjustments to the program, but they re-established Q 154 Falls Assessment.

Q: What is the order of payment reductions on a claim with the CQ or CO modifier? 

A: For the therapy services to which the 15% reduction applies, payment will be made at 85% of Medicare’s (80% payment). This is based on the lesser of the actual charge or applicable fee schedule amount for claims with a CQ or CO modifier. The beneficiary’s co-insurance is deducted after the application of the MPPR to the PE Payment for all “always therapy” codes. The 2% sequestration reduction is always applied last.

Q: Regarding Remote Therapeutic Monitoring…can patients self-report their medical data? What about non-physiological data? 

A: Yes, patients can log their own data into RTM portals using a medical device. Patients can report non-physiological data such as their home program compliance, pain level, medication, etc.

Q: Do we still have the direct supervision rule where a PT has to be present in an outpatient private setting? 

A: The physical therapist is required to be onsite with the PTA as part of the Direct Supervision rule in a private practice under Medicare. During the pandemic, therapists were granted a form of “general supervision” which allows audio-visual supervision as an alternative to direct supervision. General supervision is expiring at the end of 2022, meaning the A/V supervision option will be eliminated and therapists in private practice will be required to utilize “direct supervision” i.e., on-site. Changing this rule would require legislative action. 

Follow and support the bill for PTA/OTA General Supervision, called the HR 5536 “SMART” ACT. Write and talk to your congressman about it. It makes no sense for therapists in private practice to be held to the direct supervision requirement, while other comparable settings have general supervision prerogatives.

Q: How many evaluations can we bill in a year? What length of time? ex: every 30 days, 60 days etc. 

A: There are multiple considerations to keep in mind, including:

  • What does your Practice Act state regarding the therapist’s responsibility/requirement for evaluating new patients and/or conditions? If it stipulates specific requirements, those must be followed regardless of payment for services.
  • An evaluation or reevaluation is required by Medicare if the patient presents with new conditions or diagnoses. These can impact the Plan of Care Goals and Treatment Plan and should be performed and billed accordingly. Medicare typically expects a change/modification in an existing Plan of Care if an Evaluation or Reevaluation is billed. Of course, recertification of the new Plan of Care is also required.

Q: We’ve noticed that the G0283 CPT code is being denied as not medically necessary. Is this a trend for the future? Is there some other way we should be billing this code? 

A: The G0283 modifier is not a bundled code, so that is not the problem. Have you affixed the appropriate other modifiers i.e., GP or KX, if applicable?

Some Medicare Administrative Contractors (MACs) have Local Coverage Determinations (LCDs) that limit the frequency of certain modalities. Visit your MAC’s website to see if there is an LCD for Physical Therapy/Therapy Services.

There is no other way to bill G0283, and doing so could constitute a False Claims Act violation. Always bill according to the CPT code’s definition.

Q: If the owner/PT signs all notes, will there be any reductions for PTA’s?

A: An owner or other therapist cannot circumvent the intent of this rule by signing notes for services performed by a PTA/OTA. If the owner is not the person providing the service, that could become a False Claims Act violation. There is CQ or CO exemption by cosigning for services provided by an assistant. 

If the PTA treats the patient, you must comply with the regulation that specifies when the CQ or CO modifiers must be used. There are a number of scenarios that are included in the Medicare Physician Fee Schedule Proposed Rule (July 2021) which you can reference. 

Q: What is Locum Tenens? 

A: Locum Tenens (Fee-for-Time) is the use of a substitute provider to cover for an enrolled provider in his or her absence in specific situations. There is an important bill on the Hill entitled Nationwide PT/OT Access to Locum Tenens, S2612 & HB1611, which we encourage you to support. 

Access to Locum Tenens would give therapists the ability to be in compliance with Medicare rules in situations where they need someone to cover for them. Just like any other type of provider, therapists run into situations where they have emergencies, personal matters, or are short-staffede, and have to get another therapist to provide care to active patients. Today, therapists don’t have that prerogative. If you’re using a PRN therapist who is not enrolled and you choose to bill under someone’s number who is not the providing therapist, you have a potential False Claims Act violation.

If this bill goes through, therapists would be able to utilize another therapist who is not enrolled in Medicare. The clinic would bill under the therapist being replaced and would pay the locum tenens therapist for the time or per visit. If you’re using a PRN therapist who is not enrolled and you choose to bill under someone’s number who is not the providing therapist, you have a potential False Claims Act violation.

Q: If the Access to Locum Tenens bill goes through, will it be available for Medicaid as well?

A: We don’t know. Medicaid has state policies, and those policies have to be dealt with on the state level. Policies can vary from state to state and that may be one area that may not follow Medicare coverage policies.

Q: What is the status of Sequestration going into 2022? Will the sequestration be reinstated?

A: Sequestration is a 2% reduction in payment that has been mandated since 2013. It was suspended during the pandemic, but yes, it will eventually be reinstated. It is legislatively required and would take congressional action before 2022 to be halted. 

Q: What if you choose to go non-par w/ Medicare and/or refuse to see Medicare patients? 

A: You can choose non-participation, but you still must be enrolled in Medicare. Therapists do not have the prerogative to “Opt-Out” of Medicare. You can either enroll or not enroll. If you are enrolled, you can participate by accepting assignments of benefits. If you choose not to participate, you are choosing not to accept assignments, but you still must be enrolled and file claims for the patient. Under non-participation enrollment, you may bill up to the limiting charge, which is 15% more than Medicare. In order for that to work, you have to be prepared to collect cash at the time of service. 

Those therapists with cash-based practices typically have a population of patients that are willing and able to pay cash upfront. In the non-participation situation, the patient will get reimbursed at 95% of the Medicare allowable within a few weeks of claim submission by the clinic. Remember, they will also be paying up to the additional 15% allowable upcharge. 

The success potential of choosing to be a non-participating provider is slim if your practice serves patients on a fixed or limited budget. The result of electing this payment strategy will limit patient access due to financial constraints. 

Q: Is there any update from Medicare and/or other commercial or federal payers regarding covering telehealth (or virtual visits) for PT?  

A: Today, telehealth services provided by therapists are allowed through the end of the year in which the year the pandemic is declared over. Since the Public Health Emergency was extended on October 15th, telehealth services by therapists will be permitted through 2022. If there is no congressional action and the pandemic is declared over in 2022, therapists will no longer be able to provide services via telehealth in 2023. We are not statutorily listed as telehealth providers. 

Q: Does the Emergency Regulation Requiring COVID-19 Vaccination for Health Care Workers apply to outpatient clinic employees, regardless of # of Employees? If so, does it apply to ALL employees, regardless of contact with patients?

A: What we know right now is that OSHA’s COVID-19 Vaccination Emergency Temporary Standard took effect upon its publication in the Federal Register (November 4, 2021). Employers must comply with most requirements within 30 days of the publication and with testing requirements within 60 days of publication. Employees will have the option of vaccination or weekly testing. There are medical, religious and other exceptions. Employer fines for non-compliance are massive.

Unsure how to plan for 2022 given the looming reimbursement cuts?

Download the 2022 Planning Tool for Private Practice Owners.

Each year, Inc. Magazine calculates the fastest-growing private companies in the United States and ranks them on its Inc. 5000 list.

Having achieved a  276% growth rate over the last three years, Breakthrough is excited to announce that we’ve made the list for the second year in a row.

The team at Breakthrough is honored to receive this kind of national recognition and we are grateful to the community of Private Practice owners we get to work with every day. 

Our company’s mission is to help people in pain get back to normal naturally by working with PTs who provide their patients with the highest quality care. 

The fact that this is the second year in a row Breakthrough made the Inc. 5000 list is a testament to our marketing software’s ability to help physical therapists grow their businesses and see real results from their online advertising. Unlike other solutions, practice owners appreciate the ability for Growth X to bring patients in from the community who had never heard of the practice before.

Carl Mattiola, CEO of Breakthrough PT Marketing

Continued Growth in 2020 and Beyond

inc. 5000 list breakthrough pt marketing

There have been many hurdles affecting the private practice industry over the last few years. According to PT in Motion, there was a 54.5% decrease in physical referrals to Physical Therapy between 2003 and 2014.

CMS proposed a 9% cut to physical therapy reimbursements earlier this month.

And on top of everything else, the entire world has been affected by the COVID-19 pandemic, with many practices being forced to close their clinics during state-wide lockdowns. 

But the tide is shifting and now many owners are bouncing back to their pre-COVID numbers. Some Breakthrough members are even reporting higher patient visits than any other period this year.