Eli's Rehab Report

Published on Fri Jan 02, 2015 PDF

Start now and avoid penalties later.

If you’re a PT, OT, or SLP in private practice, you need to be participating in the Physician Quality Reporting System … yesterday. Therapists have no new measures to learn for 2015, but if you haven’t yet reported on the existing ones, you’ll see an immediate cut to your Medicare reimbursement.

Nonparticipation of eligible providers in 2013 launched the payment penalties, which will show up in 2015 at -1.5 percent. Subsequently, those who did not participate in 2014 will be subject to a -2 percent penalty in 2016, and those who do not successfully participate in 2015 will be subject to a -2 percent penalty in 2017.

In 2015, therapists are required to report up to nine measures — if the measures pertain to their respective discipline.

Watch for: If you’re reporting via claims, fewer measures will be available to report, as opposed to registry reporting, notes Gayle Lee, JD, senior director of health finance and quality for the American Physical Therapy Association. Also, “one of the major changes is that some of the measures that could be reported last year, are not reportable in 2015 (such as the back pain measures group),” she adds.

“There are no new measures for eligible OTs to report on in 2015, however measure #182, Functional Outcome Assessment, is an important measure that was added in 2014 and is reportable by eligible OTs,” says Sharmila Sandhu, JD, director of regulatory affairs for the American Occupational Therapy Association.

Also the same as for 2014, you must report on at least 50 percent of Medicare patients to whom the measures apply.

For SLPs: Measures will continue to be the documentation of medication (measure #130) and pain assessment and follow-up (#131). “Last year pain assessment was optional; however, CMS has not yet released their Measures Applicability Validation process to know if that is the same for 2015,” says Lisa Satterfield, MS, CCC-A, director of health care regulatory advocacy for the American Speech-Language-Hearing Association.