Therapy assistant differential

Definition

Medicare pays fifteen percent less for a minute an assistant delivered than for the therapist's own.

Why It Matters

Assistant leverage is the standard way a clinic makes money, and on the Medicare share of the book it is worth 85 cents on the dollar. Two things follow. A seller's revenue per visit normalizes differently depending on staff mix, so a clinic that has moved work to assistants since the trailing year is less profitable than the trend line suggests: ask for units by credential, not by therapist. And the modifier is mandatory on the claim, so a clinic leveraging assistants without appending it has been overpaid, which is the buyer's problem in a stock deal and an indemnity fight in an asset deal.