Therapy assistant differential

Definition

Medicare pays fifteen percent less for a billed unit an assistant furnished more than a tenth of.

Why It Matters

Read the unit and not the minute, because that is where the rule bites. Medicare pays 85 cents on the dollar for a billed unit an assistant furnished more than a tenth of, flagged by a modifier that is mandatory on the claim. Below that tenth there is no reduction at all, so a clinic can use assistants heavily and lose nothing on a unit the therapist mostly delivered. Two things follow. Revenue per visit normalizes differently by staff mix, so ask for units by credential and not by therapist. And a clinic leveraging assistants without the modifier has been overpaid, which is the buyer's problem in a stock deal.