Welcome to the HealthPRO Heritage Blog

American Taxpayer Relief Act of 2012-Regulatory Update

On New Year’s Day Congress passed the American Taxpayer Relief Act of 2012. The main purpose of this legislation was to stop the automatic tax increases and federal budget cuts that took effect on January 1, 2013. This legislation also included provisions related to the Medicare program.

  • PART B REIMBURSEMENT:  There is now a delay to the planned cut in Medicare reimbursement for all services paid by the Physician Fee Schedule which include outpatient therapy services.  The announced spending cut for payments was to be 26.5% for 2013. Under the legislation, the conversion factor is set at 0, which means payments will remain relatively unchanged for 2013.  Specifics related to the impact on therapy CPT codes to follow. 
  • MULTIPLE PROCEDURE PAYMENT REDUCTION (MPPR): For therapy services furnished on or after April 1, 2013 the 25% multiple procedure payment reduction is increased to 50% for all providers. 
    • Previous legislation set the therapy cap for 2013 at $1900 for PT/ST combined and $1900 for OT.
    • The therapy cap extension process has been extended to 12/31/13.
    • The therapy cap is extended to hospital outpatient settings through 12/31/13.
    • The therapy cap is extended to therapy furnished as part of outpatient critical access hospital services.
    • The Manual Medical Review process is extended through 12/31/13 for claims at or above $3700 for PT/ST combined and a separate $3700 for OT.
  • SEQUESTRATION CUTS: Postponed until March 1, 2013. Under these cuts Medicare providers would see a 2% reduction in payment.

Additional information will be provided as clarification is received from our national associations.

If you have questions related to these changes, please contact your Regional Vice President for clarification.


Tags: nursing home operations, nursing home occupancy, skilled nursing facility, medicare