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The analysis of any legal or medical billing is dependent on numerous specific facts — including the factual situations present related to the patients, the practice, the professionals and the medical services and advice. Additionally, laws and regulations and insurance and payer policies are subject to change. The information that has been accurate previously can be particularly dependent on changes in time or circumstances. The information contained in this web site is intended as general information only. It is not intended to serve as medical, health, legal or financial advice or as a substitute for professional advice of a medical coding professional, healthcare consultant, physician or medical professional, legal counsel, accountant or financial advisor. If you have a question about a specific matter, you should contact a professional advisor directly. CPT copyright American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.

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Merit-Based Incentive Payment System (MIPS)

Physical and occupational therapists in private practice who exceed all 3 criteria of the low-volume threshold must participate in MIPS, subject to the payment adjustment of +/-9%. Nonparticipation will result in the full 9% penalty. 

In 2022, PTs and OTs will need to participate in 2 of the 4 MIPS categories, Quality Measures and Improvement Activities.  This course will cover all of the requirements that PTs an OTs must do in order to avoid the penalty and receive the 7% payment increase.

MIPS Eligibility

    • Eligible Clinician Types
    • Low-Volume Threshold
    • Reporting as an Individual or Group

Physical and Occupational Therapy Quality Measures

    • Diabetes Mellitus: Diabetic Foot and Ankle Care, Peripheral Neuropathy – Neurological Evaluation
    • Diabetes Mellitus: Diabetic Foot and Ankle Care, Ulcer Prevention - Evaluation of Footwear
    • Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan
    • Documentation of Current Medications in the Medical Record
    • Preventive Care and Screening: Screening for Depression and Follow-Up Plan
    • Falls: Risk Assessment
    • Falls: Plan of Care
    • Elder Maltreatment Screen and Follow-Up Plan
    • Functional Outcome Assessment
    • Functional Status Change for Patients with Knee Impairments
    • Functional Status Change for Patients with Hip Impairments
    • Functional Status Change for Patients with Lower Leg, Foot or Ankle Impairments
    • Functional Status Change for Patients with Low Back Impairments
    • Functional Status Change for Patients with Shoulder Impairments
    • Functional Status Change for Patients with Elbow, Wrist or Hand Impairments
    • Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention
    • Dementia Cognitive Assessment
    • Dementia: Functional Status Assessment
    • Education and Support of Caregivers for Patients with Dementia
    • Falls Screening for Future Fall Risk
    • Functional Status Change for Patients with Neck Impairments
    • Measures Removed

Improvement Activities

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Therapy Comply is a healthcare compliance firm that seeks to bring high quality web-based compliance guidance and one-on-one consulting services to small and medium size physical, occupational, and speech therapy practices.

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