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
therapy cap
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
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
CMS Posts FAQ on Manual Medical Review by Recovery Auditors (RACs)
RAC ‘n Rehab© Series CMS, without much fanfare, released a long anticipated Frequently Asked Questions document regarding manual medical review of therapy claims over the $3700 thresholds. The FAQ is in reponse to the questions posed by the therapy stakeholder group a number of weeks ago prior their meeting with CMS on how the manual medical review would be implemented. … Read More
Therapy Cap for 2009 Announced Transmittal R1851 (CR6660)
CMS has announced the therapy cap for 2010 is $1860, representing a $20 increase over the 2009 therapy cap. Transmittal R1851 to the Medicare Claims Processing Manual, dated 11/13/2009 and the accompanying MLN Article MM6660 provide information on the implementation. The Balanced Budget Act of 1997 (BBA) established a $1500 therapy cap for physical therapy … Read More
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