Nancy Beckley & Associates

therapy cap

Compliance, CORFs, RACs 3 Comments

Expedited Review When Therapy Services are Discontinued

Faced with $1900 therapy caps, and $3700 manual medical review by Recovery Auditors (RACs) therapy providers are cautious about providing therapy services that may not be deemed medically necessary by Medicare contractors.  In light of the change in liability for therapy over the $1900 cap in 2013, therapy providers have a choice of obtaining a mandatory ABN, using the GA modifier to … Read More

Compliance, RACs 4 Comments

CMS to Therapy Providers: Change to Payment Liability for Therapy Cap Denials

Change to Payment Liability for Therapy Cap Denials 

In this week’s edition of CMS eNews there was an important update for therapy providers regarding the change of liability for therapy denied as exceeding the therapy caps ($1900 for PT and SLP combined, and a separate $1900 for OT) in 2013.  Currently Remittance Advices (RA) are indicating beneficiary liability for denials resulting from denials for therapy over the caps.  … Read More

Compliance 3 Comments

ABN for Therapy Over the Cap in 2013: CMS FAQ Posted

Have Your Cake and Eat It Too?  Not so fast…. the ABN rules have changed for 2013 Therapy

Have you been issuing a blanket ABN notice to therapy outpatients when they reach the $1900 therapy cap ($1900 for physical therapy and speech therapy combined, and another $1900 for occupational therapy) wherein the patient accepts financial responsibility for therapy if CMS deems it is not medically necessary?  … Read More