Mississippi PT Students Raise Funds for Physical Therapy Research

This year physical therapy students from Mississippi were among the 79 schools that participated in the 2021-2022 VCU-Marquette Challenge to raise $170,221.98 in support of the Foundation of Physical Therapy Research (FPTR).  FPTR wishes to thank the students of William Carey University for their strong support of the Challenge. William Carey University raised $3,000.00 and reached the Honorable Mention Award. Since its inception in 1989, over 300 different schools have participated in the Challenge, raising over $4.6 million for research.

The Marquette Challenge is student-led fundraising effort to advance the mission of FPTR. Although this year there were still barriers due to the ongoing pandemic, hundreds of physical therapy and physical therapy assistant students found inventive ways to hold events across the U.S to fund physical therapy research and advance their future profession. Over the years, this support has helped FPTR fund more than 650 researchers nationwide. FPTR remains appreciative of the commitment of PT students from Mississippi in supporting physical therapy research.

The top fundraising schools for 2021-2022 include:

  • 1st place: Virginia Commonwealth University (VCU)
  • 2nd place: The University of Delaware
  • 3rd place: The University of Miami

For the 3rd year in a row, the first-place winner of the Challenge was Virginia Commonwealth University (VCU) by raising $23,054. FPTR welcomes VCU to co-host the 2022-2023 Marquette Challenge. Although there is a friendly competition between schools, participation at any level is what matters. We would like to thank all the participating schools for their hard work this year. A recording of the 2022 FPTR Awards Ceremony can be viewed here: https://marquettechallenge.com/

The Challenge supports grants, scholarships, and a rigorous peer review process. This research funding is an investment in the physical therapy profession. In addition to improving care, research shows the value of physical therapy to patients and payers alike. Every aspect of physical therapy – from education to practice – is bolstered by quality research. Our research propels innovation that helps people get better faster.

Brad Corr of Boys Town National Research Hospital is the recipient of the $40,000 2021 VCU-Marquette Challenge Grant. His trial “Powering Through Transition: Therapeutic Power Training for Adolescents and Adults with Cerebral Palsy” will examine Therapeutic Power Training as a way to optimize mobility for adolescents and young adults with cerebral palsy. The Challenge also funds a PODS scholarship, which this year will be awarded to Chris Lane at The University of North Carolina at Chapel Hill for his project “Preventing Disability after Anterior Cruciate Ligament (ACL) Injury: Examining Opportunities in those at Greatest Risk”.

Please join me and other students in supporting the 2022-2023 VCU-Marquette Challenge

Faculty and students in the state of Mississippi are encouraged to visit the Marquette Challenge website at marquettechallenge.com to learn how they can support FPTR and physical therapy research through the 2022-2023 VCU-Marquette Challenge.

About the Foundation for Physical Therapy Research

The Foundation for Physical Therapy Research was established in 1979 as the only national, independent nonprofit organization solely dedicated to funding physical therapy research. Since its inception, FPTR has awarded more than $20 million in research grants, fellowships, and scholarships to more than 665 promising researchers. Many of today’s leading physical therapy researchers, clinicians, and academicians began their careers with this support. Foundation-funded researchers have gone on to secure more than $894 million in follow-on funding. www.foundation4pt.org/donate

APTA-Backed Bipartisan House Bill Takes Aim at PTA Differential

The SMART Act would delay implementation, spare rural and underserved areas, and relieve PTA supervision burdens.

There could be a temporary reprieve in the works for the startup of the PTA payment differential — and a possible exemption for rural and underserved areas — thanks to a bipartisan bill introduced in the U.S. House of Representatives. APTA has been strongly advocating for congressional action to mitigate the proposed 15% reduction in Medicare payment for services delivered by PTAs and occupational therapy assistants.

The bill, called the Stabilizing Medicare Access to Rehabilitation and Therapy Act, or SMART Act (H.R. 5536), was introduced by Reps. Bobby Rush, D-Ill., and Jason Smith, R-Mo. (Read the press release issued from Rep. Bobby Rush’s office.) If signed into law the legislation would delay implementation of the payment differential until Jan. 1, 2023, and provide an exemption to the differential for rural and underserved areas. APTA and other advocates have criticized the differential for having a disproportionately harmful effect on patient access to needed therapy services in these areas.

The proposed legislation would also institute a change long-advocated by APTA: allowing for general supervision of PTAs in outpatient settings under Medicare Part B. Medicare currently allows for general supervision of PTAs by physical therapists in all settings — except for outpatient practice under Part B, which requires direct supervision. Currently 44 states allow for general supervision of physical therapist assistants, making this Medicare regulation more burdensome than most state requirements.

APTA offers a quick, easy way for individuals to contact their legislators to urge support of the bill by way of the APTA Patient Action Center.

“APTA has been urging CMS to implement these policy changes to mitigate the PTA payment differential,” said Justin Elliott, APTA vice president of government affairs. “But now we need Congress to intervene. We’re grateful to representatives Rush and Smith for their leadership on this legislation to ensure continued patient access to therapy services provided by PTAs.”

Along with APTA, the legislation has been endorsed by a number of other provider and patient groups, which expressed their gratitude in a recent letter of support to the bill’s sponsors.

In the letter, the groups note that the rehab therapy sector has yet to recover from the impact of the COVID-19 pandemic, writing that the differential “hits hardest where therapy assistants are needed most — in underserved areas in both rural and urban communities.” The letter also points out that rehab therapy is an effective approach to the management of acute and chronic pain and a way of reducing or eliminating the use of opioids. “These treatment options will not be available if we do not have the therapy providers to furnish these services,” the groups write.

“The legislation introduced is a beginning pathway to prevent the disruption in therapy services under Medicare to those that need it the most — a need that will only increase as our population ages,” said David Harris, PTA, MBA, chief delegate of the APTA PTA Caucus “PTS and PTAs are critical to providing these skilled and much-needed therapy services, especially in rural and underserved areas, and continuous Medicare cuts only create roadblocks to quality patient care. I applaud this effort to protect patient access to these services.”

Read more on the APTA website.

COVID-19 isolation and quarantine period shortened 

The Centers for Disease Control and Prevention (CDC) has announced it has shortened the recommended isolation and quarantine period for people with COVID-19 to five days, if asymptomatic and if persons can wear a mask when around others. 
These updates are recommended as the Omicron variant continues to spread throughout the U.S. and reflect the current science on when and for how long a person is most infectious. Emerging information with the Omicron variant demonstrates that the majority of SARS-CoV-2 transmissions occur early in the course of illness, generally in the one to two days prior to the onset of COVID-19 symptoms and the two to three days afterward. The new CDC recommendations for the general population mean that asymptomatic people who test positive may leave isolation five days after testing if they can continue to consistently and correctly mask for five more days to minimize the risk of infecting others. Infected persons who cannot follow mask guidance after five days, for example, young children, need to remain in isolation for 10 days after testing positive. 
In addition, CDC is updating the recommended quarantine period for those exposed to COVID-19. For people who are unvaccinated or if they are more than six months past their second dose of mRNA vaccine (Pfizer or Moderna) or more than two months after their Johnson and Johnson vaccine and not yet boosted, CDC now recommends quarantine for five days followed by strict mask use for an additional five days. 
If a five-day quarantine for vaccinated, not yet boosted, persons is not feasible, it is imperative that an exposed person wear a well-fitting mask at all times when around others for 10 days after exposure. Individuals who have received their booster shot do not need to quarantine following an exposure, but they should wear a mask for 10 days after the exposure. 
For all those exposed, CDC states that best practice would also include a test for SARS-CoV-2 at the fifth day after exposure. If symptoms occur, individuals should immediately quarantine until a negative test confirms their symptoms are not attributable to COVID-19. 
Everyone is urged to continue to follow recommendations to be vaccinated and those 16 years of age and above to be boosted to reduce severe disease, hospitalization and death. According to CDC, data from South Africa and the United Kingdom demonstrate that vaccine effectiveness against infection for two doses of an mRNA vaccine is approximately 35 percent. A COVID-19 vaccine booster dose restores vaccine effectiveness against infection to 75 percent.
Vaccination remains the best way to protect yourself and others and to reduce the impact of COVID-19 on our communities in light of recent studies showing that the previously widely available monoclonal antibody treatments are not effective against the Omicron variant. 
Definitions of isolation and quarantine are as follows. Isolation relates to behavior after a confirmed infection. Isolation for five days followed by wearing a well-fitting mask will minimize the risk of spreading the virus to others. Quarantine refers to the time following exposure to the virus or close contact with someone known to have COVID-19. 
Visit https://msdh.ms.gov/msdhsite/_static/14,0,420.html for more information on COVID-19.

Medicare Legislative Package Signed Into Law

This afternoon President Biden signed S. 610, the Protecting Medicare & American Farmers from Sequester Cuts Act, into law.  As previously noted the legislation will do the following:

  • CMS will receive a 3% appropriation for 2022 to partially offset its planned 3.75% cut to the conversion factor used to set payment for codes used by providers.
  • Implementation of a looming 4% across the board “pay as you go” cut mandated through budget rules will be postponed until 2023.
  • A temporary moratorium on the 2% Medicare sequestration cut required by law since 2011 as part a deficit spending mechanism will be continued through part of 2022. The moratorium will last until April, when a 1% sequestration will return, with the full 2% sequestration reduction beginning in July.

The Stabilizing Medicare Access to Rehabilitation and Therapy Act, or SMART Act (H.R. 5536) aimed at addressing the PTA differential wasn’t included in the last-minute legislative package approved by Congress; however lawmakers will return in early 2022 to address a long list of critical issues they did not finish before the end of this year. We are already working with our congressional allies to push for passage of the SMART Act in 2022.

Thank you for your advocacy!

New Physical Therapy Bill Introduced

On Monday Senator Jon Tester (D-MT) and Senator Roger Wicker (R-MS) introduced the APTA-supported legislation Physical Therapist Workforce and Patient Access Act (S. 2676).This legislation would allow physical therapists to participate in the National Health Service Corps Loan Repayment Program. The program involves 2 year contract to work in a health professional shortage area in exchange for a $50,000 loan repayment

The addition of physical therapists to the NHSC Loan Repayment Program will ensure that individuals in rural and underserved areas have access to nonpharmacological options for the prevention, treatment, and management of pain, and access to physical therapy for rehabilitation from postacute sequelae of COVID-19, often called long COVID.

The legislation aligns with APTA’s strategic priority and Public Policy Priorities, 2021-2022 of addressing student loan burdens in physical therapy.

This bill was introduced as a Senate companion bill to the existing house bill (HR 3759) that was introduced in July. Stay tuned for advocacy opportunities to support this legislation.

Medicare Sequestration Moratorium Extended

This afternoon the U.S. Senate passed a compromise bill led by Senator Shaheen (D-NH) and Senator Susan Collins (R-ME) to extend the moratorium on the Medicare Sequestration. The Senate compromise bill will provide a 9-month extension of the moratorium on the -2% Medicare sequester through the end of 2021. 

While we await official word from House Leadership, we do expect the House to pass this Senate proposal upon its return in mid-April and will be signed by President Biden.

The current moratorium on the -2% Medicare sequestration expires on March 31. The extension of the moratorium will likely not be enacted until mid-April at the earliest. This will result in a temporary, 2-3 week period beginning April 1 when the -2% Medicare sequestration will be in effect.  We hope that CMS will hold claims submitted on and after April 1 until the extension is enacted; however, it is unclear whether CMS will do so. We are currently seeking guidance from CMS. While we await clarification from CMS, we recommend that for dates of service on and after April 1, providers consider holding their claims until after enactment of the moratorium extension.

APTA has been actively engaged on this issue including joining a recent joint letter to congressional leaders from national health care groups urging Congress to extend the moratorium. APTA members, patients, and supporters have engaged with their members of Congress on this issue via the APTA Action Center.

Thank you for your advocacy.  Please stayed tuned for additional updates.

The new conversion factor released by CMS helps to offset the impact of fee schedule reductions for PT providers.

What began as a projected 9% cut in payment to PTs under Medicare and was later reduced to an estimated 3.6% cut may be whittled down even further thanks to a recently announced change to how payment is calculated. The change comes by way of an adjustment to the conversion factor, the multiplier applied to relative value units to determine Medicare Part B payment amounts. That figure changed from CMS’ planned $32.41 (precise number: $32.4085) rate to $34.89 ($34.8931) for 2021.

The new conversion factor is still a drop from the 2020 conversion factor of $36.09 ($36.0896), but one that’s far less severe than originally approved — a 3.32% decrease compared with the 10.2% reduction in the final fee schedule.

The result: The smaller cut, coupled with targeted provisions in a spending and COVID-19 relief bill enacted in late December, will help to blunt the effects of changes adopted by CMS that threatened to reduce physical therapy payment by an estimated 9%. Even before factoring in the changes to the conversion factor, the congressional action reduced the effects of the cuts from 9% to an estimated 3.6% for PTs.

How It Works Out for Payment

In some coding situations, the combination of factors may result in cuts less than the estimated 3.6%. For example, payment for therapeutic exercise (CPT code 97110) will drop by an average of 3.3%, from $31.40 in 2020 to $30.36 this year, with manual therapy (97140) seeing a similar percentage decrease, from $28.87 in 2020 to $27.91 in 2021. Neuromuscular reeducation (97112) drops by 2.35% (from $36.09 to $35.34), while CPT code 97530, for therapeutic activities, sees a 2.45% decrease from its 2020 level of $40.42 to $39.43 in 2021.

In a few instances, the new payment levels could even result in slight increases, particularly for PTs conducting an evaluation or reevaluation. For example, in 2020, use of evaluation CPT codes 97161-97163 resulted in a payment of $87.70; that payment increases to $101.89 in 2021. Similarly, payment for reevaluation CPT code 97164 will also increase this year, from $60.30 in 2020 to $69.79. (Noteactual amounts vary by locality).

Increases to the office/outpatient evaluation and management visit codes billed by primary care and some specialty physicians were at the heart of payment cuts to some three dozen professions that CMS says it was forced to implement to maintain budget neutrality. The CMS plan sparked an intensive advocacy effort at both the agency level and on Capitol hill, including historic levels of participation from APTA members and supporters fighting the cuts.

Cuts Still “Unsustainable”

While the new conversion factor is good news for PTs, the damage inflicted by CMS remains — and must be addressed, according to Kara Gainer, APTA’s director of regulatory affairs.

“The updated conversion factor and COVID relief provisions helped us partially dig out of the hole we were put in by CMS, but even with those wins, we’re still facing cuts that are simply unsustainable and damaging to patient access to needed care,” Gainer said. “We need not only to continue to advocate for more relief, but also to engage in a serious dialogue about whether the current physician fee schedule system is an antiquated response to the current demands of our health care environment.”

The new conversion factor will be integrated into the 2021 version of APTA’s Fee Schedule Calculator. Those changes should be loaded into the system in the coming weeks. APTA will share news of the updated calculator when it’s available.

Update on the Proposed 9% CMS Reimbursement Cut

Because of your work, Congress reduced the cut from 9% to an estimated 3.6%.  The fight continues and we are immensely grateful for the over 120,000 emails to Congress, taking every opportunity to raise your voice with legislators, and sending over 25,000 comments to CMS.  This campaign has been enormous and we are appreciative of your time and efforts.

View a full statement from APTA president Sharon Dunn

Win: CMS Will Lift Several Code Pairing Restrictions

After an on-again, off-again approach to rules affecting the billing of code pairs that represent common, appropriate physical therapy practice, the U.S. Centers for Medicare & Medicaid Services has announced it will accept many of the pairs it had barred for use, or required to be accompanied a modifier if they were used on the same day. The changes, pressed for by APTA, are expected to reduce use of code modifiers that were creating confusion and sparking claim denials.

The good news arrives by way of the Jan. 1, 2021, edition of the National Correct Coding Initiative’s procedure-to-procedure edit tables, a listing of which CPT codes are prohibited from being billed together unless paired with the 59 or X modifier — or simply can’t be paired at all, meaning that if both services are performed on the same day only the first is paid for. In the new edit set that will take effect on Jan. 1, many of these problematic code pairs have been resolved. The retroactive change applies to both office and facility-based settings.

APTA led successful efforts to lift the restrictions, arguing that the edits not only ran counter to best practice, but were forcing overutilization of the 59 and X modifiers. That overuse led some commercial payers to adopt problematic policies that slowed and sometimes even denied claims that were submitted with the required modifier.

This latest development caps off a year that gave many PTs the equivalent of coding whiplash: The original 2020 version of the edits list included prohibitions on several code pairings commonly used in physical therapy; CMS responded to advocacy by APTA and its members and reversed that decision in early February. Then, in April, CMS responded to additional APTA advocacy and lifted more edits, only to reinstate them on Oct. 1. The latest announcement paves the way for a more settled coding environment in 2021.

The code pairing restrictions deleted in both office and facility-based settings include:

97110 with 97164
97112 with 97164
97113 with 97164
97116 with 97164
97140 with 97164
97150 with 97164
97530 with 97116
97530 with 97164
99281-99285 with 97161-97168
97161-97163 with 97140
97127 with 97164
97140 with 97530
97530 with 97113

In its announcement, CMS says that some of the positive changes are retroactive to Oct. 1, 2020, with others retroactive to Dec. 31, 2019. APTA has reached out to CMS and its NCCI contractor to get more answers on the deletion dates and provisions that could allow reprocessing of previously denied claims. The association also will update the code pairing chart available on its Medicare National Correct Coding Initiative webpage.

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