On January 1, 2013, Congress passed the American Taxpayer Relief Act of 2012. The Act extends the Medicare therapy cap exceptions process through December 31, 2013. The automatic exceptions process will apply when patients reach the $1,900 threshold and the manual medical review process will continue at the $3,700 threshold. Hospital outpatient settings will continue to be included under the therapy cap with the exceptions process in 2013. Additionally, the Act averts the 26.5 percent payment cut caused by the sustainable growth rate formula and extends the geographic practice cost index for one year. The Act also delays sequestration cuts until March 1, 2013, avoiding a 2 percent cut in reimbursement rates for Medicare providers.
Despite the passage of the above critical provisions, Congress included an increased multiple procedure payment reduction (MPPR) to therapy services provided on the same day. The Act increases MPPR from 20 percent in private practice and 25 percent in facilities, to 50 percent for all settings. This provision will not begin until April 1, 2013 and APTA will advocate aggressively to prevent implementation of this flawed policy. For more information on MPPR, review the attached Congressional summary of the Medicare extender offsets.
In addition to this legislation, several policies took effect today, including:
- In 2013, Physical therapists must submit information regarding a patient’s functional limitation for Medicare Part B services. For more information visit APTA’s Functional Limitation Reporting webpage.
- The Physician Quality Reporting System (PQRS) changes from an incentive-based program to a penalty program in 2013. In order to avoid penalties of 1.5 percent in 2015 physical therapists can report a variety of measures. See APTA’s PQRS webpage for more information.
- A 4 percent increase in payments went into effect on January 1 due to the final year of a practice expense survey conducted by APTA. Members will see a 4 percent increase in Medicare payments.
The American Taxpayer Relief Act of 2012 will now be sent to the President’s desk for signature.