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Tag: therapy cap

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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Therapy Over the Cap

September 8, 2015 1 Comment
Therapy Over the Cap

It’s that time of the year when therapy providers are carefully reviewing the potential for therapy over the cap for each of their Medicare patients.  Beneficiaries may need to exceed the therapy cap for several reasons:  A single complicated episode of care. Multiple related episodes of care. Multiple unrelated episodes. Using both physical therapy and speech therapy in the […]

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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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Strategic Health Solutions Reports CMS Therapy Audit Results

May 13, 2014 4 Comments
Strategic Health Solutions Reports CMS Therapy Audit Results

Strategic Health Solutions just posted CMS Therapy Audit Results of one of their outpatient therapy audits.  Strategic conducted two audits involving outpatient therapy last summer.  The first audit topic was related to therapy stoppage at the end of the year 2012  (or at the cap), and then resumed in the new year (2013).  The second […]

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Therapy Cap Reprieve April 1, 2014

April 1, 2014 2 Comments
Therapy Cap Reprieve April 1, 2014

There has been a therapy cap reprieve on this the fast day of April, 2014:  April Fools Day.  The “Stop the Therapy Caps” campaign was ultimately not successful, and one could argue that the only success out of the late breaking House and Senate Bills over the past week has been that we are in […]

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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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Therapy Caps at Critical Access Hospitals

January 24, 2014 0 Comments
Therapy Caps at Critical Access Hospitals

Therapy caps at critical access hospitals (CAH) are now in full implementation effective 1/14/2014.  Last year the utilization of therapy at CAH was applied toward the cap, but there was no limitation on the amount of medically necessary therapy that could be provided as the KX modifier was added by CMS only to properly register a […]

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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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