Industry Changes that Impact Rehab Providers 2023

Industry Changes that Impact Rehab Providers 2023

Every year Medicare brings about new rules that impact rehab providers.  Below is a summary of those changes.

The final CY 2023 PFS conversion factor is $33.06, a decrease of $1.55 to the CY 2022 PFS conversion factor of $34.61.

Annual Therapy Threshold: $2,230 for PT and SLP combined, and $2,230 for OT, an increase from $2,150 in 2022

-Application of KX modifier will still be necessary to attest to medical necessity for services above $2,230.00 in 2023

Targeted Medical Review: Remains $3,000

GPCI adjustment: Awaiting final numbers to be published

Part B Deductible: $226

-If Part B deductible has been met prior to the Medicare beneficiary receiving outpatient therapy services, then the Medicare beneficiary would have the full annual therapy threshold dollar amount

MIPS 2023

While MIPS Value Pathways (MVPs) has been on the radar, there is no specific MVP for rehab therapists beginning 2023; we’re likely to see a specialty measure subset beginning 2024.  Traditional MIPS program is scheduled to end on December 31, 2027, and be replaced by MVPs beginning on January 1, 2028.

Performance Categories

For rehab therapists (PT, OT, SLP), Cost and Promoting Interoperability Categories are not being reported, and the value for those categories are reweighted to the “Quality” category. 

The % remains the same as from Performance Year 2022:

Quality: 85%

Improvement Activities: 15%

Small practices will be reweighted as follows:

Quality: 50%

Improvement Activities: 50%

Performance Threshold 

75 points (neutral adjustment)

There is no longer an exceptional performance threshold bonus as of Performance Period 2023.

Data Completeness – MIPS eligible clinicians will continue to meet the current data completeness threshold of 70% (e.g., must report at least 70% of eligible cases for each Quality measure) for the 2023 performance periods.

Quality Measure Scoring • Final Score Points between 0.0 – 18.75: Negative 9%

• Final Score: 18.76 – 74.99: Negative MIPS payment adjustment greater than negative 9% and less than 0% on a linear sliding scale

• Final Score: 75.0: 0% adjustment

• Final Score: 75.01 – 100: Positive MIPS payment adjustment greater than 0% on a linear sliding scale. The linear sliding scale ranges from 0 to 9% for scores from 75.00 to 100.00

The following quality measures are being added to the PT/OT Specialty Set for the 2023 MIPS Performance Period:

• Quality Measure 048: Urinary Incontinence: Assessment of Presence or Absence of Urinary Incontinence in Women Aged 65 Years and Older

• Quality Measure 178: Rheumatoid Arthritis (RA): Functional Status Assessment

• Quality Measure 487: Screening for Social Drivers of Health

Due to the points needed for just a neutral adjustment to occur, it is HIGHLY recommended that any therapists required to participate in MIPS (or any that are choosing to opt in) sign up with a QCDR to submit MIPS measures on your behalf.  Quality measure #130, Documentation of Current Medications in the Medical Record, is being removed from reporting via claims.

Remote Therapeutic Monitoring

Remote Therapeutic Monitoring (RTM) codes were specifically designed to monitor non-physiologic data related to the respiratory or musculoskeletal systems. It also covers monitoring patient adherence and response to therapy, including home exercise program compliance.  What makes these codes different, however, is that therapists can now bill Medicare and other insurances for exactly the kind of work that many have considered essential to achieving good clinical outcomes for years.

RTM Service Codes

98975: Remote therapeutic monitoring (e.g. respiratory system status, musculoskeletal system status, therapy adherence, therapy response); initial set-up and patient education on use of equipment. 

98976: Remote therapeutic monitoring (e.g. respiratory system status, musculoskeletal system status, therapy adherence, therapy response); device(s) supply with scheduled (e.g. daily) recording(s) and/or programmed alert(s) transmission to monitor respiratory system, each 30 days

98977: Remote therapeutic monitoring (e.g. respiratory system status, musculoskeletal system status, therapy adherence, therapy response); device(s) supply with scheduled (e.g. daily) recording(s) and/or programmed alert(s) transmission to monitor musculoskeletal system, each 30 days

RTM Treatment Management Codes

98980: Remote therapeutic monitoring treatment, physician/other qualified health care professional time in a calendar month requiring at least one interactive communication with the patient/caregiver during the calendar month; first 20 minutes

98981: Remote therapeutic monitoring treatment, physician/other qualified health care professional time in a calendar month requiring at least one interactive communication with the patient/caregiver during the calendar month; each additional 20 minutes

Average National Reimbursement for RTM:

98975: $19.58

98976: $55.72

98977: $55.72

98980: $49.56

98981: $39.90

Check out our recent blog on RTM for more information, and our 5-part webinar series  that details RTM as well as our new RTM suite that makes participating and earning revenue with RTM simple.

If you would like a demo of our new RTM suite, please contact us to schedule a preview!