Have Your Voice Heard: The CMS Proposed Rule Comment Period Ends Next Week

Have you heard?

Buried in the CMS proposed rule for 2020, there is a proposed 8 percent decrease in the Medicare fee schedule for physical and occupational therapy starting in 2021. According to CMS, the reductions are driven by changes to reimbursement formulas for E&M services provided by physicians and some other providers.  

Separately, according to the proposed rule, “beginning on January 1, 2020, outpatient therapy providers will be required to use a modifier to denote when outpatient therapy services are furnished in whole or in part by a physical therapy assistant (PTA) or occupational therapy assistant (OTA).” 

Further, the proposed law also states that in 2022, a 15 percent decrease in the fee schedule will take effect for services performed by assistants.

What does this mean?

If finalized, these rules will put significant financial pressure on outpatient therapists, especially in rural and underserved areas where access to PT and OT is already limited.  

Specific to the assistant modifier rule, should it go into effect, it will have a detrimental impact on reimbursement for services furnished in-part or in-whole by our valued PTAs and OTAs, reducing to 85 percent of the fee schedule.

Additionally, it poses significant consequences for our profession and the patients we serve. If the reduced payment rate takes effect, patient’s access to physical and occupational therapy services will be at risk resulting in delayed care and, ultimately, poorer outcomes.

What can you do about it?

Luckily, the comment period isn’t over. The CMS proposed rule is open for comments until September 27, 2019, ahead of CMS publishing its final rule in early November 2019. We, and much of the outpatient rehab community, believe that there is power in numbers. With a strong showing of people opposing these policies, we hope that CMS can take a second look and modify the upcoming physician fee schedule. If you’re as fired up about this as we are, have your voice heard.

Here are the links you need to know:

I recently hosted a webinar with Medicare compliance expert, Nancy Beckley, discussing the latest proposed updates from Medicare. Learn more on the proposed rule and its implications for your practice. Watch the recording here.

6 thoughts on “Have Your Voice Heard: The CMS Proposed Rule Comment Period Ends Next Week

  1. Please do not limit the work of OTAs and PTAs. I am an OTA and the majority of the patients I treat in the outpatient setting is Medicare. This would detriment my livelihood and the livelihood of my fellow colleagues.

  2. I believe a lot of the blame falls on these businesses placing assistants in leadership positions over the therapists.
    You will never see a LPN seated as a director of nursing, nor a PA as a medical director. It is only in therapy where you will find a PTA or COTA in a position of authority over a DPT, SLP, OTD, etc. We’ve brought this on ourselves by letting this mockery go on for this long. Tell me otherwise.

  3. KG,
    Maybe you should step up and lead. Licensure doesn’t equal leadership skill. If you have been passed up for a leadership position and see that someone with ‘lesser’ degree is telling you what to do, maybe you are just a minimalist and you are the problem. Advance your personal skill set and advance your career and take on leadership roles. Learn to lead from the bottom and maybe you will be given greater authority when you prove yourself to the organization.

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