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Tag: $3700 threshold

Therapy Manual Medical Review Again

July 5, 2016 2 Comments
Therapy Manual Medical Review Again

Here we go again!  Therapy manual medical review again! Just when the therapy community, particularly those in private practice, were thinking that CMS forgot about manual medical review of outpatient therapy over $3700 CMS opted a stealth move, the though an update to the therapy cap website.  It represents a long-awaited announcement, but not a particularly welcome […]

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Medicare Therapy Cap in 2016

November 25, 2015 2 Comments
Medicare Therapy Cap in 2016

The Medicare therapy cap in 2016 is set at $1960.  The therapy cap for physical and speech-language pathology combined is set at $1960 and there is a separate $1960 therapy cap for occupational therapy.   This represents an increase of $20 per cap over the 2015 amount of $1940.  The increment is based upon a medical […]

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RAC Therapy Reviews Underway: 2014 Therapy Claims

February 26, 2015 3 Comments
RAC Therapy Reviews Underway: 2014 Therapy Claims

RAC therapy reviews are underway as CMS paved the way for manual medical review of therapy claims over the $3700 threshold by the Recovery Auditors (RACs). Effective January 16th CMS provided a contract addendum to the current (outgoing) RACs in all 4 regions to begin a review of therapy claims over $3700 submitted between March […]

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$3700 Therapy Threshold RAC Reviews

December 4, 2014 1 Comment
$3700 Therapy Threshold RAC Reviews

$3700 therapy threshold RAC reviews have resumed even though the larger RAC program has been “paused”.  Therapy over the $3700 per beneficiary thresholds ($3700 for PT & SLP combined, another $3700 for OT) is mandatorily reviewed for medical necessity.  CMS has assigned the review task to the RACs.  According to information provided by CMS to the […]

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2015 Therapy Cap Values

November 26, 2014 1 Comment
2015 Therapy Cap Values

CMS has announced the 2015 Therapy Cap values for 2015 for physical therapy and speech-language pathology combined and occupational therapy.    The therapy caps were initiated under the Balanced Budget Act of 1997 (P.L. 105-33, Section 4541(c)) to implement a per beneficiary annual cap (financial limitation) on the amount of therapy services under Medicare Part B.  The original […]

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RAC Restart Facts…(Not Rumors)..So Far

August 12, 2014 2 Comments
RAC Restart Facts…(Not Rumors)..So Far

The therapy community is abuzz with all the rumors and misinformation on the RAC restart facts. So far there are a few things that we do know.  We know that CMS wrote letters to members of Congress on Friday August 1st announcing their intention to have a limited restart to the “paused” RAC program. We also know […]

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CMS to Restart Some RAC Reviews

August 4, 2014 3 Comments
CMS to Restart Some RAC Reviews

CMS announced today that it is initiating contract modification with the current Recovery Auditors in Regions A, B, C and D to restart reviews of a limited number of issues.  While CMS had previously announced that new Recovery Auditor (RAC) contracts would be announced for Regions 1-5 no later than August 15th their announcement today […]

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RAC Work Pause and Therapy Manual Medical Review

February 24, 2014 1 Comment
RAC Work Pause and Therapy Manual Medical Review

The CMS RAC Work pause of the Recovery Auditor (RAC) program will provide some work load relief for outpatient therapy providers in the short run, but in the long run 100% of therapy claims over the $3700 thresholds will be reviewed.  So what does this mean for therapy providers?  Check your mail, if you are […]

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RAC Audit Stoppage Not Likely to Affect Therapy ADR

February 20, 2014 2 Comments
RAC Audit Stoppage Not Likely to Affect Therapy ADR

CMS announced this week that the Recovery Audit program (RACs) would pause for a period of time so that the current ADR requests can process through the RAC reviews.  RAC audit stoppage is not likely to affect therapy ADRs.  In what might have been a false sense of “freedom” rehab providers reading RAC Monitor’s special […]

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Appealing Medicare Denials – 5 Things You Must Know

February 11, 2014 0 Comments
Appealing Medicare Denials – 5 Things You Must Know

Appealing Medicare denials is likely to be a reality for all outpatient therapy providers this year. Therapy over the $3700 cap is subject to 100% mandatory medical review by the Recovery Auditors (RACs) through 3/31/2013.  In fact those reviews, if not favorable, will first frustrate you, then possible anger you, then compel you to file an […]

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