5 Things Practice Owners Need to Know in 2021

Posted by Daniel Ramsey on January 20, 2021
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1. PTA/OTA Reimbursement Cut Takes Effect in 2022

It’s been a year since CMS implemented CO/CQ modifiers for services provided “in whole or in part” to Medicare patients by PTAs and OTAs. In 2022, CMS will be reducing reimbursements by 15% for services with CO/CQ modifiers.

If you believe your practice may be impacted by these reduced reimbursements, you need to use these next twelve months to research new revenue opportunities and fine-tune your revenue cycle management to guarantee money isn’t being left on the table.

2. Medicare Rate Change/ Cap Change

CMS approved the 9% cut to Part B physical and occupational therapy rates in December 2020. These cuts were supposed to become effective in 2021 but due to the COVID-19 Relief Package, the expected cuts are going to be around 3.6%.

For the latest news about CMS reimbursements and compliance, we recommend contacting Nancy Beckley or Rick Gawenda.

In 2021, the Medicare therapy cap has increased to $2,110 and Part B deductible has been raised to $203. If your patient needs additional visits after they’ve met their cap, providers can continue treatment as long as their document proves medical necessity and proper modifiers are applied to the claim.

3. Turnover Hurts Profits

If you struggle to keep long-term staff, you may be losing more revenue than you realize. One study revealed that it can take one to two years before an employee is fully productive. Which means if your staff is leaving after 6-12 months, you must reset the clock to zero with a new candidate.

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You can learn more about reducing turnover in our resource, “The Ultimate Guide for Reducing Turnover at the Front Desk”.

4. New Providers Need to Be Credentialed

Any time you hire a new provider to your practice, they need to be credentialed with your in-network insurance carrier mix. This is the only way to ensure your practice is billing compliantly. You and your managers should begin the credentialing process as soon as the job offer is accepted.

Getting your provider in-network and linked to your group can take 30-90 days. Certain insurance companies may allow in-network providers to co-sign notes until the out-of-network provider is credentialed. Be sure to check with your front desk and billing staff before scheduling certain patients with out-of-network providers.

5. Practice Changes Need to Be Updated with Insurance Carriers

All practice demographic changes need to be reported to your in-network insurance carriers. Whether it is a change of practice address, new phone number, or provider name change. If you do not send demographic updates to the insurance company and confirm the information has been updated in their system, claims can be denied, and reimbursement will be delayed.

If you believe your practice may be impacted by the reduced reimbursements these next twelve months will be critical to evaluate and research new revenue opportunities. Put new procedures in place to fine tune your revenue cycle management to guarantee money is not being left on the table.


If you are looking to increase revenue or improve practice productivity in 2021, give us a call at 508-422-0233 for a strategy call.

[FREE RESOURCE] The Ultimate Guide for Elminating Turnover at the Front Desk

Topics: Billing, Credentialing, Management

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