Yes, the Therapy Cap was eliminated! After 20 years of lobbying efforts by the therapy industry and other organization representing the interests of Medicare beneficiaries, Congress passed H.R.1892, The Bipartisan Budget Act of 2018. The elimination of the therapy cap was effective January 1, 2018. …
The therapy cap sunset. What happens now? The 20 year “Stop the Therapy Cap” campaign came to an end with the passage of the Bipartisan Budget Act of 2018. The therapy cap was permanently eliminated, so there is no need to worry, at the end of each year, to lobby for carry over of the therapy cap exceptions process.
Here is a recap of the therapy cap sunset provisions:…
The Medicare therapy cap was initiated with the Balanced Budget Act of 1997 (BBA). What? Yes, this year marks the 20th year of therapy cap legislation as well as the 20th year of the therapy industry’s efforts to “stop the therapy cap”. The therapy cap has been a permanent fixture since 2006, 11 years ago. From 1997 – 2006 there were a few implementation stops and starts, however the therapy industry was successful in keeping a moratorium in place on implementation of the caps until 2006….
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 announcement, as we still don’t have substantive details on who is going to be targeted for manual medical review of therapy claims over the $3,700 cost threshold….
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 economic index. The therapy “threshold” for manual medical review (MMR) continues at $3700, where it was initiated in the 4th quarter of 2012….
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 same year, as they come under the same therapy cap.