April 10, 2015
With an increase in the treatment limits and decrease in reimbursements, it has become difficult for many physical therapists to run a profitable business. Besides revenue challenges, lack of time and skilled resources are also making it difficult for them to comply with stringent government regulations scheduled this year.
They are struggling to balance their time between quality care and error-free claims processing and medical billing. Amidst these challenges, adapting to policy and payment changes have made them anxious about the future.
Challenges for Physical Therapy Practices in 2015
Eligible professionals (EPs) including physical therapists who fail to report data on PQRS quality measures for the reporting period between 1st January 2015 and 31st December 2015 will have to face a 2.0% adjustment in their fee schedule in 2017.
Physical therapists will also be facing changes to medication measures, chronic wound care measures and the elimination of low back pain measures. If a physical therapists wishes to participate in PQRS in 2015, he/she will have to review 2015 measures specifications. These specifications contain detailed information on how to report a measure along with information on quality data codes for reporting.
Various payment updates have also been issued by the CMS for outpatient physical therapy. These payment and policy changes will be impacting physical therapists (PTs) as well as home health providers in 2015.
Changes that are effective from 1st January 2015 till 31st December 2015 include an annual therapy cap, amounting $1940 (2% increases) for PTs and speech language pathology combined. There is also a separate cap amount of $1940 for occupational therapy. Second effective change is the requirement for PTs in private practices for reporting 9 measures or 1-8 measures if 9 not applicable via registry or claims under the PQRS program. By meeting these requirements, PTs can avoid a 2.0% payment penalty scheduled for 2017.
Due to the changes in policies and payments, physical therapists might face financial challenges in 2015 which will also affect the quality and access to patient care. The APTA (American Physical Therapy Association) works every year to protect physical therapy services from payment cuts. The association has been advocating the repeal of therapy cap and preventing pay cuts from going into effect. However, even though various regulations have been passed to protect payment, PTs are not immune to reimbursement changes that affect Medicare providers.
With so much to be handled in 2015, PTs are not able to pay attention to the most important tasks like medical billing. Due to lack of monitoring, their in-house billing team is not handling the revenue cycle in the desired manner. To avoid revenue disruptions, many PTs are outsourcing their physical therapy billing to experts in the medical billing industry.
Through outsourcing, they have been able to eliminate worries related to hiring and training coders and billers, upgrading systems, HIPAA compliance and adaptation to other regulatory changes.
As a dedicated team is assigned to take care of timely payments, maximum collections and denial management, they are getting sufficient time to focus on other vital changes that might affect their practice in the coming months.
Outsource Medical Billing