Minimizing the Impact of the 15% Medicare Part B Cuts

The proposed 2022 15% reduction in Medicare Part B reimbursement for treatment provided by PTA’s and COTA’s is rapidly approaching. Providers need to consider how to best minimize the impact this proposal has on their reimbursement. PTA’s and COTA’s are valuable clinicians in all therapy settings and they will continue to have a role in the treatment of patients but there are ways to manage their caseloads so that your reimbursement isn’t negatively impacted for the quality care you are providing your patients.

PT’s and OT’s are required to perform evaluations, recertifications, and 10th visits but many of them still have available time in their day for the treatment of patients. One strategy could be to assign the Medicare B caseload to PT’s and OT’s for the remainder of their workday. This would avoid this 15% reduction in reimbursement. Part B patients are generally not seen every day of the week which can help facilities who may not have a full time PT or OT. In those instances, Part B patients can be scheduled on the days that the PT or OT will be in the facility.

For those providers with an in-house therapy programs and multiple SNF locations, at times a PTA or COTA may be the only one available to see the Medicare Part B patients and that may still make sense in some situations. Given the lower cost of using a PTA or COTA, it may be more cost effective to have them treat a single Medicare B patient, than traveling a more costly PT or OT when there is nothing else required for the PT or OT to complete at the facility that day. For those providers who use contract therapy companies, your therapy provider may be thinking this way too, but this may not be what is best for your organization. Speaking with your therapy provider and making your expectations known when it comes to treatment of Medicare B patients will be important. This conversation would be an opportune time to review your contact in relation to how Medicare B reimbursements are split. This is especially important if your therapy provider is unable to provide an adequate plan for Medicare B patients to be treated by PT’s and OT’s. At Axis we have developed several strategies and recommendations for nursing home providers to minimize the impacts of the cuts, whether you have an in-house therapy program or use a contract therapy provider.