CMS Reimbursement Rules for 2021

Cutting Therapy

The Trump Administration issued new reimbursement rules that cut funding for therapy to nursing home residents. CMS announced the final rules for physician pay, and cutting physical and occupational therapy payments for nursing homes patients by 9%. Last year, therapy providers took an 8% cut.

Lobbyists for the nursing home industry have warned over these reductions. They are pressuring politicians to reverse the Trump decision.

The new rules do not make any sense for the nursing home industry. Nurse practitioner services also get a pay increase (7%) but only in an office setting; when billed in a nursing facility, there will be a decrease. Physicians also got a significant pay raise.

“The action that CMS took to finalize these policies that impact nursing facility patients is shocking in that CMS is significantly cutting services that help our patients recover from COVID or keep themselves healthy and hopefully not succumb to COVID-19,” said Cynthia Morton, VP of the National Association of Support for Long Term Care.

“Services like rehab therapies that patients need to strengthen their mobility after being in a bed for a long time, X-rays to detect problems in their lungs from COVID-19, and nurse practitioner services are being cut. CMS is …cutting these vital services pretty deeply that are going to hurt provider’s abilities to provide these critical services,” she added. 

Telehealth

The Trump administration emphasized the increase for telehealth services. Telehealth services are controversial. Studies indicate communication and comprehension decrease with telehealth. Health and Human Services Secretary Alex Azar said:

“During the COVID-19 pandemic, actions by the Trump administration have unleashed an explosion in telehealth innovation, and we’re now moving to make many of these changes permanent. Medicare beneficiaries will now be able to receive dozens of new services via telehealth, and we’ll keep exploring ways to deliver Americans access to healthcare in the setting that they and their doctor decide makes sense for them.”

Telehealth can also be abused and create more waste and fraud in the nursing home industry. For example, CMS created two new payment codes (G2010 and 22012) to cover billings for remote care.  However, there is no way to guarantee the health care provider provided the remote care. The agency even allows telehealth services even if a physician or practitioner is in the same building!

Telehealth includes clinical social workers, psychologists, physical and occupational therapists and speech language pathologists. They can now provide short online assessments and management services, as well as virtual check-ins and evaluations services. How can you do a full assessment without touching the resident?

CMS Fact Sheet

A CMS fact sheet on the expansive pay rule can be found here. Under the flag of the administration’s “Patients Over Paperwork” initiative, CMS finalized these changes:

• Certain non-physician practitioners such as nurse practitioners and physician assistants can supervise the performance of diagnostic tests within their scope of practice and state law, as they maintain required statutory relationships with supervising or collaborating physicians.
• Physical and occupational therapists will be able to delegate “maintenance therapy” to a therapy assistant.
• Physical and occupational therapists, speech-language pathologists, and other clinicians who directly bill Medicare can review and verify, rather than re-document, information already entered by other members of the clinical team into a patient’s medical record. Officials say this will allow practitioners to have the flexibility to delegate certain types of care, reduce duplicative documentation, and supervise certain services they could not before.