CMS has issued a proposed rule for the Medicare Physician Fee Schedule (June 25) that would reduce Part B therapy rates for many procedures commonly provided to nursing home residents to be implemented 1/1/2011.
The proposed reduction would come from CMS implementing a downward adjustment in payments when multiple procedures are performed on the same patient on the same day. This payment adjustment has long been the practice for surgical procedures, more recently was applied to imaging, and was recommended for therapy payments by GAO. See below for more detail.
Some rehab companies serving nursing homes have estimated that this will mean approximately a 10% reduction in Part B therapy payments. The effect on individual nursing homes will depend on how each home’s contract with the therapy company works.
Therapy companies have argued that the cuts are unreasonable and will require more group therapy. CMS has argued that the cuts are long warranted, are necessary for prudent management of Medicare, and will potentially benefit patients because they will be able to get more therapy before running into problems with the therapy caps (which are based on costs).
AAHSA is beginning an analysis and welcomes comments.
The relevant part of the proposed rule begins on page 134. Comments are due Aug 24.