Physical Therapy
Compliance in PT: The Good, the Bad and the Ugly
Knowing everything there is to know about compliance is necessary as a private practice owner. Here are some things to keep in mind.
The buzz around MIPS may have you wondering what you must do to remain compliant and maximize reimbursement. Here’s a quick overview that can help you take the right steps.
The very first step is to figure out if you are required to participate, eligible to participate or exempt/ineligible to participate. To learn your participation status, visit the Center for Medicare and Medicaid Services (CMS) Quality Payment Program (QPP) Participation Status webpage here.
Once you have entered your NPI information, your participation status will be revealed.
NOTE: Even if an individual therapist does not meet the minimum thresholds, practices or groups billing under a single Tax Identification Number (TIN) may.
If you meet all three criteria, your participation in MIPS is required. If you meet at least one of the minimum thresholds for participation, and you work in a facility that is not exempt or ineligible, you are eligible to opt-in.
If you are eligible to opt-in, but not required, WebPT has created a “MIPS Participation Quiz” that might help you with this decision. (Take the quiz here).
It is currently recommended to participate for those that are eligible as the Medicare Fee Schedule will otherwise be frozen for the next five years. If you are required to report, you must report, or you will be subject to a reduction in your Medicare reimbursement over the next five years. If you are eligible to report and opt out of participation you will not see an increase in your Medicare reimbursement for the next five years. If you are eligible to report and opt into participation you will see as much as a 7% increase in your Medicare reimbursement over the next five years by meeting the minimum reporting requirements and achieving the minimum score or rating to achieve that increase.
For 2019, the MIPS program only requires successful reporting on 60% of your total patient volume. CMS has also put together some great resources to educate and train your teams. For many, your participation in MIPS and where you currently stand is going to come down to what EMR you are working with and can be a good resource to you for questions. If you are not using an EMR today, or your system does not already have a method to report, a good alternative is Keet.
Schedule a call with a FYZICAL Advisor for more information.
