With the New Year upon us, HW&Co. would like to wish you a happy, healthy and prosperous New Year. As always, the New Year brings many changes to the Long-Term Care Industry. We are pleased to provide you with updates on some of these changes.

In this issue:
1. 2020 Part B Fee Schedules
2. Part B Services Provided by Therapy Assistants
3. Expected Cuts to Part B Therapy Rates in 2021
4. Therapy Caps Update
5. Multiple Procedure Payment Reduction Remains in Effect
6. Make Sure your PS&R System Login is Active!
7. 2020 Medicare Part A Coinsurance & Medicare Part B Deductible
8. January 1, 2020, Ohio SNF Medicaid Rates
9. Medicaid Benchmarking Reports Now Available


2020 Part B Fee Schedules

In conjunction with the Medicare Access and CHIP Reauthorization Act of 2015, which replaced the Sustainable Growth Rate (SGR) formula with new systems for establishing payment updates to the Medicare Part B physician fee schedules, the 2020 physician fee schedules will receive a .1% update. However, in conjunction with the final rule for 2020, various adjustments to some of the underlying factors that are used to calculate the payments will be made effective January 1, 2020. As a result, the changes to the payments for each code will vary, in some cases widely, from the reported update.

The Therapy fee schedules provided below are effective from January 1, 2020, through December 31, 2020. It is important to forward the fee schedules to your business office personnel to use for January bills. Our Revenue Cycle Consultants are available to assist with any billing questions you may have. In addition, if you use PointClickCare, the Part B fee schedules are automatically updated in your system.

2020 Ohio Therapy Medicare Part B Fee Schedule 

Many of the fee schedules change or are updated on a quarterly basis. Please review the appropriate schedule based on the Centers for Medicare & Medicaid Services (CMS) updates. Check the CMS website on a regular basis for updates to these schedules. Please note that these schedules are not all-inclusive. We have attempted to limit this information to the most commonly used Healthcare Common Procedure Coding System (HCPCS) codes for long-term care facilities.

Fee schedules for lab, radiology, PEN, and DMEPOS services are also available. These fee schedules may be helpful in negotiating contracts with your ancillary service providers. Please contact your HW Healthcare Advisor if you would like a copy of one of these fee schedules for 2020 services.

Part B Services Provided by Therapy Assistants

As required by federal law, CMS has introduced new billings modifiers for services provided by physical and occupational therapy assistants. Effective January 1, 2020, the CO and CQ modifiers must be included when a therapy assistant provides all of the service billed under a given code. If a therapist is involved throughout the entire service, no modifier is required. At this time, the modifiers will not impact Part B reimbursement. However, beginning in 2022, Part B reimbursement for services provided by therapy assistants, as indicated by the modifiers, will be reduced by 15%.

Expected Cuts to Part B Therapy Rates in 2021

As part of the 2020 Physician Fee Schedule final rule, CMS included a plan to increase reimbursement rates for office/outpatient evaluation and management (E/M) codes. While physical and occupational therapy services do include some E/M codes, the majority are billed and paid to various physician specialties. Effective January 1, 2021, CMS will adopt revised E/M code definitions from the American Medical Association.

In order to maintain budget neutrality for the Physician Fee Schedules, CMS has proposed to reduce reimbursement rates for other services, including physical and occupational therapy, which are expected to be reduced by as much as 8% effective January 1, 2021. The American Physical Therapy Association, among others, has stated it will work over the next 12 months to avoid the reimbursement cuts.

Therapy Caps Update

The therapy caps for Part B therapy services were eliminated in the Bipartisan Budget Act of 2018. However, the KX modifier must still be used when services over the limits are provided as a provider attestation of medical necessity. The limits for 2020 are $2,080 for physical and speech therapy (combined) and occupational therapy. The budget act also lowered the threshold for targeted medical reviews of therapy claims from $3,700 to $3,000.

Multiple Procedure Payment Reduction Remains in Effect

The Multiple Procedure Payment Reduction (MPPR) remains in effect for 2020. The MPPR cuts the practice component of the fee schedule payment for certain HCPCS codes by 50% when more than one kind of therapy is provided to a resident in a single day.

For 2020, the MPPR covers therapy services billed under 51 different HCPCS codes. The last column of the therapy fee schedules provided above shows the payment that would be made under the MPPR for the affected therapy codes.

Make Sure your PS&R System Login is Active!

Just a quick reminder that passwords for the CMS PS&R system expire every 60 days and must be changed. In addition, to avoid being locked out, the PS&R system must be accessed at least once every six months. We recommend you address any password or login issues now to avoid delays in accessing your PS&R reports for the Medicare cost reports due in May.
Please contact your HW Healthcare Advisor if you have any questions on accessing the PS&R system.

2020 Medicare Part A Coinsurance & Medicare Part B Deductible

Effective January 1, 2020, the Medicare Part A coinsurance rate for SNFs will increase to $176 per day from $170.50 for days 21 through 100. The Part B deductible will be $198.00 for 2020, up $13 from 2019.


January 1, 2020, Ohio SNF Medicaid Rates

Ohio skilled nursing facility Medicaid rates have undergone many changes between January 1, 2019, Therapy Ohio 2020 and January 1, 2020. These changes include the introduction of a market basket inflationary increase on July 18, 2020, and a new quality incentive on January 1, 2020. Rate letters were posted to providers’ MITS portals in early January. We recommend you review them closely to ensure the rates are being calculated correctly. For more information on the January 1, 2020 nursing facility Medicaid rates, please click here to see the article we have posted on our website.

Medicaid Benchmarking Reports Now Available

The 2018 Medicaid Nursing Facility (NF) Cost Report database from ODM and the ICF-IID cost report database from DODD allow us to analyze annual cost, census, and staffing trends. We can compare your facility’s expenses, census and staffing against selected competitors, as well as county, peer group and statewide averages. These reports provide valuable information to assist you in optimizing the operations of your facility. Please contact us if you are interested in a benchmarking report.


Steve Anderson CPA