Home Health & Hospice Week

HHAs furnishing Part B therapy may feel the pinch.

The probable lack of a physician reimbursement fix isn't all good news for home health agencies.

Legislators neglecting to increase Medicare payment rates for physicians may mean the home care  rate increase stays intact for 2007 (see Eli's HCW, Vol. XV, No. 40). But payment rates for the four G-codes that are related to home health and hospice physician supervision, certification and recertification--G0179, GO180, GO181, and GO182--are down by double-digit margins. Providers hope adequate payment for physicians' time spent on home care patients results in more patients referred to home care.

And not only will therapists face a $1,780 cap on physical therapy/speech-language pathology and the same cap on occupational therapy in 2007, but the final physician fee schedule aims to squeeze extra dollars from therapy services as well.

Payment for Part B outpatient physical therapy services will drop up to 10 percent in 2007 under the final regulations the Centers for Medicare & Medicaid Services released for the physician fee schedule, according to the American Physical Therapy Association. That will affect home health agencies that furnish Part B outpatient therapy to non-homebound patients.

The payment cut is the result of a 5 percent reduction in the 2007 conversion factor and an additional 5 percent budget neutrality adjustment to account for changes in relative work values as part of the fee schedule's five-year review.

No Therapy Cap Exceptions

As far as the therapy cap, it will no longer include the exceptions process created earlier this year (see Eli's HCW, Vol. XV, No. 9), unless Congress takes action to extend that process and block the payment cut before Jan. 1, 2007. The cap applies only to Part B outpatient therapy, not therapy furnished under a home health plan of care.

Congress has an opportunity to address the fee schedule cuts and therapy-cap exceptions process in the post-election lame duck session that began Nov. 13 and resumes after Thanksgiving. Proposed bill S. 3912/H.R. 6132 would extend the current Medicare therapy cap exceptions process set to expire on Dec. 31, APTA notes.

"The current therapy cap exceptions process has maintained access to needed rehabilitation services in a fiscally responsible manner," says APTA President R. Scott Ward.

In addition to helping seniors maintain health, the bill "will even save money by helping individuals stay out of inpatient facilities," Sen. John Ensign (R-NV) comments.

But experts believe it's unlikely that legislators will take action on Medicare legislation. That means Medicare therapy patients will have to choose between no treatment or paying 100 percent out of pocket when their Medicare coverage runs out, APTA says.

Ray of light: Therapy proponents hope for a more long-term solution that completely repeals the caps next year. The bill to repeal the therapy caps (S. 438/H.R. 916) has strong bipartisan support in the outgoing House and Senate with 259 and 44 cosponsors, respectively, APTA says.

Note: The fee schedule is at www.cms.hhs.gov/physicianfeesched/downloads/1321-fc.pdf?agree=yes&next=Accept.