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2023 - Make the New Year your BEST YEAR!

Updated: Dec 15, 2022


As you prepare to change the calendar be prepared for the changes that will affect your outpatient rehabilitation practice.

Sound Medical Billing Solutions can make the New Year your BEST YEAR!


  • Medicare Deductible and Therapy Cap Thresholds

2023 Medicare Deductible: $ 226.00 (- $ 7.00)

2023 Medicare Therapy Cap: $ 2,230.00 (+$ 80.00)

Targeted Medical Review: $ 3,000.00 (no change)

  • 2023 Medicare Payments to be REDUCED by approx. 4.47%

Medicare is changing the Conversion Factor which is used to generate payments under the Medicare Fee Schedule.

2023 Medicare Conversion Factor will be 33.0607 (-1.5455) resulting in the following decreases in payments from 2022:

2023 Medicare Fee Schedule - (NY Locality Code 2):

Most common Physical Therapy Codes

97161 $ 113.71 (- $ 5.72) 97112 $ 38.25 ( - $ 2.46)

97164 $ 79.84 (- $ 1.64) 97116 $ 33.30 ( - $ 1.79)

97140 $ 29.07 ( - $ 3.18) 97530 $ 42.57 ( - $ 2.31)

97110 $ 33.30 ( - $ 1.79) 97535 $ 37.31 ( - $ 2.01)

G0283 $ 13.86 ( - $ 0.79)

*The amounts listed do not include the Multiple Procedure Payment Reduction (MPPR)

**Contact SMBS for details regarding 2023 Medicare Fee Schedule specific to
Occupational Therapy, Chiropractic, Speech, or any other specialty.

  • Medicare Advantage Programs

The name is confusing patients and providers alike. Medicare Advantage Plans are third party commercial insurance plans that are marketed to the Medicare eligible population and are NOT a government health plan. For the provider, Medicare Advantage Plans often require

pre-authorization and network credentialing. For the patient, Medicare Advantage Plans often carry higher out of pocket expenses in the form of co-payments, co-insurances and deductibles. When asked, patients will often believe they have Medicare and may present a Medicare identification card along with a Medicare Advantage identification card.

Note: all Medicare eligible patients possess a Medicare identification card; however, this does not ensure enrollment in the government health plan.

Steps to help navigate confusion regarding Medicare Advantage Plans ensuring you will be paid:

1- identify patients with a Medicare Advantage Plan and/or changes to a patient's supplemental insurance

note: verification of benefits with Medicare will help identify patients enrolled in a Medicare Advantage Plan

2- identify the differences of the enrolled Medicare Advantage Plan to the assumed enrollment in Medicare

3- communicate patient financial responsibility and have patients sign a benefits estimate

4- collect all patient financial responsibilities at the time of service

5- acquire all necessary pre-authorizations prior to service

  • How To Increase Revenue in 2023

Here are a few suggestions from SMBS that may help you raise revenue in 2023:

- Review office procedures to ensure accurate document acquisition and insurance verification

- Create an effective front office to billing workflow that ensures valid claims

- Collect patient balances at the time of service

note: many supplemental plans do not pay the primary deductible and may require a co-payment, co-insurance, or deductible

- Eliminate courtesy forgiveness of patient balances

note: courtesy forgiveness of patient financial responsibilities can be considered a violation of contractual obligations

- Review network status credentialing to ensure PPO reductions are eliminated

- Author comprehensive defensible documentation that meets Medicare guidelines

- Analyze billing vs treatment and documentation to ensure your practice is not "underbilling"

- Develop alternative revenue sources

For additional details regarding 2023 governance or for guidance on your practice needs,

contact SMBS for a personal practice review and consultation.


We at SMBS wish you a happy, healthy, and profitable 2023!

Give us a call and we can help you make the New Year your BEST YEAR!


John Spiezio, President

Sound Medical Billing Solutions, LLC
The Outpatient Rehabilitation Practice Management and Billing Specialists!

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