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Therapy Cap Reprieve April 1, 2014

April 1, 2014 2 Comments

There has been a therapy cap reprieve on this the fast day of April, 2014:  April Fools Day.  Snails race on sports trackThe “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 the same spot we were …. and there is no movement forward in addressing the real issues facing out patient therapy providers in all practice setting.  While the therapy industry now has another opportunity to regroup and another 12 month reprieve, let’s turn to more practical matters.  What happens today forward?  Here is what we know so far that has been presented by the various therapy cap coalition Washington DC lobbyists.

Therapy Cap Reprieve Facts:

  • Physician Fee Schedule cut of 24% is delayed till March 31, 2015
  • Therapy Cap Exceptions Process (KX modifier) would be extended through March 31, 2015
  • ICD-10 delayed till October 1, 2015
  • Extends therapy caps exceptions process (use of KX modifier over $1920)
  • Manual medical review at $3700 extended
  • CMS will not need to hold claims effective with dates of service April 1, 2014

The Protecting Access to Medicare Act of 2014 (H.R. 4302), has been sent to the President for his signature.

We will have further updates over the next week and those will be via the Rehab Compliance Newsletter. (Have you subscribed?)

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Nancy Beckley

Nancy J. Beckley MS, MBA, CHC: President-Nancy Beckley & Associates LLC. Compliance outsourcing, risk assessment, compliance plans, compliance training, auditing, due diligence, investigation support for therapy providers.

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Comments (2)

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  1. Sean Slovik says:

    How does HR 4302 affect Critical Access Hospitals (CAH’s) for outpatient therapy in regards to the therapy cap?

    Prior to January 1, 2014, there was a special exemption from the therapy cap for CAH’s. Then, after the first of the year, CAH’s were treated just like anyone else.

    With passage of HR 4302, will CAH’s be like they were before January 1, 2014?

  2. Critical Access Hospitals (CAH) were added became subject to the therapy caps (and the exceptions process) as a result of the 2014 Medicare Physician Fee Schedule Final Rule. So CAHs join all other providers in being a part of the therapy caps on a permanent basis. Acute care hospitals are NOT permanently under the therapy caps, but this legislation extended the provision from the previous legislation.

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