Medicare Compliance & Reimbursement

New fee schedule and therapy caps spell bad news for your reimbursement. Not only will you be facing a $1,780-cap on physical therapy/speech-language pathology and the same cap on occupational therapy in 2007, but the final physician fee schedule aims to squeeze extra dollars from your facility as well.

Payment for physical therapy services will drop up to 10 percent in 2007 under the final regulations that the Centers for Medicare & Medicaid Services (CMS) released for the physician fee schedule, according to PT Bulletin Online.

The payment cut is the result of a 5-percent reduction in the 2007 conversion factor due to the "Sustainable Growth Rate" and an additional 5-percent "budget neutrality" adjustment to account for changes in relative work values as part of the fee schedule's five-year review.

As far as the therapy cap, it will no longer include the exceptions process created earlier this year, unless Congress takes action to extend that process and block the payment cut before Jan. 1, 2007.

Congress, however, will have an opportunity to address the fee schedule cuts and therapy-cap exceptions process when it reconvenes on Nov. 13 for a post-election lame duck session, but there is no guarantee that legislators will take action.

To see the full text of the fee schedule, visit www.cms.hhs.gov/physicianfeesched/downloads/1321-fc.pdf?agree=yes&next=Accept.