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If you have been following the APTA & the VPTA on social media or in your email inbox, you’re likely are aware of the two cuts to therapy services which are contained in the 2020 CMS Physician Fee Sch

If you have been following the APTA & the VPTA on social media or in your email inbox, you're likely are aware of the two cuts to therapy services which are contained in the 2020 CMS Physician Fee Schedule. The two cuts would impact services provided by a PTA in outpatient settings, as well as physical therapy services across the board.

In case you don't feel like reading all 1704 pages, here are the highlights as well as actions that you can take:

  • PTA Modifier:
    • The proposal is that outpatient clinics would be required to utilize a modifier when billing for any service for which a PTA (or OTA) provided more than 10% of the service. This modifier would then reduce payment by 15% for those services.
    • APTA explains the following objections to this rule:
      • The modifier is “inherently complex…[and] a gross overreach of CMS's statutory authority.” This complexity will add to administrative burden and documentation load.
      • Ignores the efficacy and value of a team-based approach.
      • Could restrict access to services and delay delivery of care, especially in rural or underserved areas as these areas often rely on the PT/PTA team to provide care to patients.
      • It would result in underpayments for outpatient services which may result in layoffs.
      • It fails to put the patient first.
  • Reduction in therapy payments by 8%:
    • The proposal would decrease payment for outpatient therapy services by a combined amount of 8%.
    • APTA explains the following objections to this rule:
      • A reduction in payments may limit therapy services which can be utilized to:
        • Save money compared to more expensive surgical procedures
        • Prevent falls and the costs related to fall injuries
        • Be a non-pharmacological substitute for pain management
      • The payment rules are not transparent and therefore can appear arbitrary.
      • Margins for therapy services are already low and further decreases may limit the ability of clinics to stay in operation. A decrease in clinics may again further decrease patient access to therapy services.

What can you do?

  • Comments on the Physician Fee Schedule are open until September 27, 2019, so make sure to submit comments soon. You can utilize the various templates found here or submit comments of your own. The templates are found under the “CMS 2020 Physician Fee Schedule Proposed Rule” heading.
    • Submit comments on both the PTA modifier rule and the generalized payment reduction rule.
    • Personalize your letters to include concerns that you may have regarding the two proposed payment reductions that may not have been addressed in the form letter.
  • To read more about the issues:
  • Be an advocate for the profession throughout the year!

We are the best advocates for our profession and for making sure that our patients are getting the services that they need. Please consider taking a few minutes to send in comments!

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