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Therapy $3700 Cap

February 6, 2014 0 Comments
Therapy $3700 Cap

The therapy $3700 cap (alternatively called threshold) is still in place for Medicare through 3/31/2014.  Claims over the therapy $3700 threshold will be reviewed by the Recovery Auditors (RACs) on either a prepayment or post-payment review basis.  Many providers use a quick estimate of $100 in Medicare allowable reimbursement per date of service, and then can […]

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Medicare Limits on Therapy Services

January 21, 2014 0 Comments
Medicare Limits on Therapy Services

CMS just posted the 2014 version of Medicare Limits on Therapy Services advising beneficiaries about the therapy caps in 2014, the Medicare deductible that they must meet and the 80% payment by Medicare, and the 20% beneficiary liability (which is often covered if a beneficiary has a supplemental or secondary policy).  Most therapy providers don’t bother […]

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Understand Physical Therapy RAC Audits- 5 Tips

January 16, 2014 0 Comments
Understand Physical Therapy RAC Audits- 5 Tips

Physical therapy RAC audits are well underway by the Recovery Auditors (RACs) in all 4 RAC regions.  Have you been on a roller coaster ride trying to figure out what is happening when you respond to the ADR to submit physical or occupational therapy documentation for review?  Feeling “up” when your ADR submission via fax […]

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Critical Access Hospitals Under Therapy Caps

January 13, 2014 0 Comments
Critical Access Hospitals Under Therapy Caps

 Critical Access Hospitals (CAH) are now under the therapy caps as noted in the 2014 Medicare Physician Fee Schedule’s Final Rule published November 27, 2013.  In 2013 CAH therapy utilization for the PT/SLP cap and OT cap counted against beneficiary therapy limits for 2013, and there was no financial consequence to the CAH.  The Medicare […]

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Therapy Prepayment Review by RACs

January 7, 2014 0 Comments
Therapy Prepayment Review by RACs

Rac ‘n Rehab Series©  Therapy prepayment review by RACs takes place in the 11 states where the RAC prepayment review is in place, the RACs have 10 days from the receipt of your records to review the records and render an opinion.  If the review is not completed in the 10 day time frame, the claim must […]

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Submitting Therapy Documentation to RACs: 3 Things You Must Know

January 6, 2014 0 Comments
Submitting Therapy Documentation to RACs: 3 Things You Must Know

Rac ‘n Rehab Series©  In the last post we described manual medical review of outpatient therapy claims that exceed one of the $3700 thresholds.  It is likely that outpatient therapy providers will be submitting therapy documentation in support of December claims though out January, and perhaps into February, in response to therapy in December. When submitting requests […]

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Manual Medical Review of Outpatient Therapy Documentation

January 5, 2014 0 Comments
Manual Medical Review of Outpatient Therapy Documentation

Rac ‘n Rehab Series©  Outpatient therapy claims for physical therapy, occupational therapy and speech therapy are subject to Medicare’s manual medical review over $3700 for 2013, and has been extended through March 31, 2014.  There is a $3700 threshold for physical and speech therapy combined, and a $3700 threshold for occupational therapy.  Since April, 2013 claims […]

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New Year for Therapy Outpatients: Five Things You Need to Know

January 2, 2014 0 Comments
New Year for Therapy Outpatients: Five Things You Need to Know

Happy New Year to Providers, and Happy New Year to all of our outpatients receiving physical therapy, occupational therapy and/or speech therapy.  At the start of the New Year, there are 5 critical elements to focus on with Medicare beneficiaries.  So let’s take a look at the New Year for therapy outpatients. The therapy caps […]

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Manual Medical Review – GAO Report of 2012 MMR Process – One Point of View

November 12, 2013 0 Comments
Manual Medical Review – GAO Report of 2012 MMR Process – One Point of View

The Manual Medical Review (MMR) of therapy claims over the $3700 thresholds in 2012 was mandated by the Middle Class Tax Relief and Fiscal Responsibility Act, which also required that the Government Accountability Office (GAO) produce a report for Congress for the 3 month (October – December 2012) program.  The GAO Report: “Medicare Outpatient Therapy […]

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Outpatient Therapy While Beneficiary is Under Home Health Plan of Care

September 20, 2013 25 Comments
Outpatient Therapy While Beneficiary is Under Home Health Plan of Care

RAC ‘n Rehab© Series Does this sound familiar?  A patient comes into your outpatient therapy clinic and states they are not receiving any home health.  You are checking because you know if that the patient is receiving home health therapy, that they can’t also receive outpatient therapy, right?  STOP right there.  Even if a patient has […]

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