Therapy 2013: What is CERTAIN in Uncertain Times

“The SNF 2013 final rule alters reimbursement rates, changes some procedure codes, penalizes providers who do don’t participate in one quality reporting system, and refuses payment for claims that fail to include other quality measures.” (12/18/12 ASHA Leader)

Outcome Reporting:

While the SNF 2013 final rule requires reporting to begin on January 1, 2013, the first six months of 2013 is being considered a transition period. Beginning July 1, 2013, in order to receive payment, CMS mandates that Part B therapy providers document G-codes on admission, discharge, and every 10th visit in the medical record.

While G-codes may not be difficult to report, they will require the coordination of your therapy team and billing department to ensure that these measures are correctly coded. These claims will not be denied nor will they be paid in the event that G-codes are not included. It is critical that your therapy team and biller work together closely to ensure that all therapy provided is coded correctly and reimbursement is received. Click Here to learn more

Therapy CAPS:

CMS has increased therapy caps to $1900 for Physical and Speech Therapy combined and $1900 for Occupational Therapy, a $20 increase from 2012.

Continued use of the KX modifier with an authorized exception for claims beyond $1900 is required until the patient reaches the $3700 threshold. Once the threshold has been met, manual medical review is required to continue reimbursable therapy services.

This process requires immense collaboration in the SNF between Social Workers, Admission Coordinators, Billers, and Therapists to accurately track what services have been received and billed in order to determine at what point modifier use and submission of manual exception paperwork is required. Ongoing collaboration is necessary as significant delays and conflicting information has been received by facilities since implementation of this process 10/1/2012. For more information visit the Novitas website

Additionally, both ZPIC Audits and the OIG pledge increased scrutiny on Skilled Nursing Facilities. During these uncertain times, it is critical to have a dependable therapy team coupled with up-to-date compliance knowledge to ensure that you are being reimbursed for care provided in your facility.

Therapy Center’s dedicated Compliance Department stays up-to-the-minute on the ever-changing and often-confusing rules and regulations. We provide on-going education to staff — our own as well as the staff in our partner facilities — to give you the peace of mind in knowing that new regulations are being met, and arming you with the tools you need to fight denials if necessary.

In these uncertain times, you cannot just continue with the status quo and hope for the best. Take a proactive step to help secure the future of your facility.


Contact Therapy Center today to receive a complimentary, customized review of your facility and a one-on-one consultation to discuss how we can help you continue your success.

Kristi Fredieu
Business Development & Marketing Manager

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