Medicare Allowable Fee Schedule, MPPR, and Cap Alerts User Guide To help our users track the Medicare Therapy Cap, WebPT offers Medicare Cap Alerts and the Medicare Allowable Fee Schedule. Additionally, as of August 9, 2013, WebPT offers Multiple Procedure Payment Reduction (MPPR) calculations. If your clinic treats Medicare patients and you wish to use the Medicare Cap Alerts system, your clinic administrator must first enable the Medicare Allowable Fee Schedule within WebPT for every clinic location. First, however, the clinic administrator will need to select the appropriate Regional Location and Facility Type within the WebPT Clinic Settings. To access the Medicare Cap Alerts and Fee Schedule settings, click on Clinic Settings, located in your clinic s dropdown menu in the top-right corner of your WebPT dashboard. Once you are in Clinic Settings, you can turn the entire Medicare Cap Alerts System on or off. If you select On for the alert system (first option), you can then choose which specific alerts you d like to enable. Please note that if you turn the entire system off, all specific alerts will remain off as well. Next, you will need to select the appropriate Regional Location and Facility Type. The Regional Location is based on the CMS Regional Location Map, which you can review here. Non-Institutional refers to private practices, whereas Institutional facilities include hospital clinics, skilled nursing facilities (SNFs), Comprehensive Outpatient Rehabilitation Facilities (CORFs), and Home Health Agencies (HHAs). Page 1 of 10
Medicare Allowable Fee Schedule Upon signing in to WebPT for the first time, each user in your clinic will see an alert stating that the clinic administrator has not completed the Medicare Allowable Fee Schedule. To bypass this alert without completing the full Medicare Allowable Fee Schedule, the clinic administrator can enter any number next to any CPT code in the Medicare Allowable Fee Schedule. However, we strongly recommend that the clinic administrator set the clinic s Regional Location and Facility Type. This will ensure no one in the clinic encounters this alert again. However, in order to enable the Medicare Cap Alerts, the clinic administrator must complete the entire Medicare Allowable Fee Schedule within WebPT. To create your Medicare Allowable Fee Schedule within WebPT, select Medicare Allowable Fee Schedule in your clinic s dropdown menu in the top-right corner of your WebPT dashboard. Page 2 of 10
Syncing Fee Schedule and Viewing MPPR Adjustments When you access the Medicare Allowable Fee Schedule after selecting a Regional Fee Schedule and Facility Type, you will notice that WebPT has adjusted the CPT codes based on your selections. Make sure Use My Regional Fee Schedule remains checked. If you (or another clinic administrator) have already created a Medicare Allowable Fee Schedule for another clinic location, you have an additional option. You can select Sync My Fee Schedule With, which allows you to sync your Medicare Allowable Fee Schedule with any clinic you choose (i.e., any changes on the first clinic s fee schedule will appear on all synced schedules). If you go this route, you will not be able to edit an individual clinic s Medicare Allowable Fee Schedule. In the interest of standardizing the Medicare Allowable Fee Schedules of clinics with the same Regional Location and Facility type, we recommend using the sync feature. This way, every change you make to the Medicare Allowable Fee Schedule for the first clinic location will automatically update in all other synced locations. Page 3 of 10
Viewing the Regional Medicare Allowable Fee Schedule in the PT, OT, and SLP Tabs Once you have selected the Regional Location and Facility Type, you can view the adjusted rates in the fee schedule on the line with the corresponding CPT code. Amounts that appear grayed out are adjusted to reflect your Regional Location and Facility Type selections. As such, you cannot edit these fields. If you see a star next to an amount, then MPPR affects the corresponding CPT code. You can still enter amounts to correspond with CPT codes not affected by MPPR or your Regional Location and Facility Types (e.g., Hot/Cold Packs in the image below). Note: If you make additional changes to the fee schedule, you must click Save, located at the top-right of your screen, to save your changes. Page 4 of 10
Accessing the Medicare Allowable Fee Schedule Change Log To access the Medicare Allowable Fee Schedule Change Log, select Change Log at the top of the Medicare Allowable Fee Schedule page, located to the right of Medicare Allowable Fee Schedule. The Medicare Allowable Fee Schedule Change Log is an audit trail of all changes a clinic administrator makes to the Medicare Allowable Fee Schedule. To return to the Medicare Allowable Fee Schedule, select View Medicare Allowable Fee Schedule at the top of the page to the right of Medicare Allowable Fee Schedule Change Log. Page 5 of 10
Patient Display The patient record will display two new items for patients with Medicare (primary or secondary): Medicare Cap OT Used/Remaining YTD Medicare Cap PT/SLP Used/Remaining YTD These items will remain at $0.00 until you complete your Medicare Allowable Fee Schedule. Additionally, if you have selected your Regional Location and Facility Type, the cap totals will reflect the MPPR adjusted values. Once you complete your Medicare Allowable Fee Schedule, you will notice these numbers reflect the CPT codes you ve entered since January 1 of the calendar year. In the example below, Red Bull has used $0.00 of his $1,900.00 Medicare Therapy Cap for occupational therapy and $0.00 of his $1,900.00 Medicare Therapy Cap for physical therapy and speech language pathology combined. Thus, he has $1,900.00 remaining year to date for OT and $1,900.00 remaining year to date for PT and SLP services. If your patient reaches or exceeds the therapy cap, the year to date totals will turn red. Note: The Amount Used column will reset to $0.00 on January 1 of each calendar year. Every year, we will update the patient display with that year s therapy cap as published by Medicare. Page 6 of 10
Medicare Allowable Cap Report Use the Medicare Allowable Cap Report to view all your Medicare patients progress toward the therapy cap. To access the Medicare Allowable Cap Report, click Medicare Cap Report located under Reports on the left-hand side of the Dashboard. Upon accessing the Medicare Allowable Cap Report, you ll immediately see all Medicare patients progressing toward the therapy cap for this calendar year. With this display, you can view: patient name last date of service the amount of the therapy cap used vs. the amount remaining or exceeding prior therapy cap amount used the case name whether a therapist has applied the KX modifier therapist type therapist initials Additionally, you can generate a PDF of the report as well as export the results to Excel. You can also click any patient name to access that patient s record. Furthermore, you can filter your results by selecting or entering start and end dates or by using the therapist type or KX modifier dropdowns. Upon choosing your filters, click Generate Report to view those specified results. Page 7 of 10
To search for a particular patient, enter the patient s full name and click Generate Report. Upon accessing an individual patient, you can view his or her overall, current, and previous therapy cap totals. Again, you can generate this data into a PDF or export to an Excel document. Medicare Cap Alerts WebPT enables you to view a patient s progress toward the therapy cap within the Scheduler. Additionally, there are a series of pop-up alerts within patient records. Pop-Up Alerts The following pop-up alerts will appear each time you open a patient record. Approaching Therapy Cap Page 8 of 10
Exceeded Therapy Cap Approaching Manual Medical Review Threshold Exceeded Manual Medical Review Threshold Cap Displays with the Scheduler Within the Scheduler, you can view a patient s progress toward the therapy cap when you: Hover Over an Appointment Page 9 of 10
Add an Appointment Edit an Appointment For questions or feedback, please contact our Support Team at 866-221-1870, option 2, or support@webpt.com. Page 10 of 10