Medicare Therapy Cap Forecast Report

Chart Links, the providers of rehabilitation workflow management software, is pleased to announce availability of the Medicare Cap Forecast Report.  The purpose of this report is to aid outpatient rehabilitation facilities in managing the CMS Medicare Part B Outpatient Therapy Cap and Exceptions Process.

The Medicare Cap Forecast Report allows Chart Links Rehabilitation Software users to generate a list of patients who may be nearing the therapy cap threshold.  The report displays amount and visit utilization for occupational therapy services as well as physical therapy and speech-language pathology services combined.

To learn about the Medicare Cap Forecast Report, please contact the Chart Links Helpdesk at (877) 701-9191.

CMS Releases Transmittal 2457 Regarding Outpatient Therapy Cap

The Centers for Medicare & Medicaid Services (CMS), on April 27, 2012, released Transmittal 2457 (Change Request 7785).

This transmittal covers therapy cap manual review thresholds.  For calendar year 2012, there will be two therapy service thresholds of $3700 per year; one annual threshold each for

(1) occupational therapy services and

(2) physical therapy services and speech-language pathology services combined.

Services will accrue toward the thresholds beginning with dates of service on and after January 1, 2012 for services with and without the KX modifier.  Beginning with dates of service on or after October 1, 2012, contractors will apply the thresholds to claims exceeding it by suspending the claim for manual review.

Further, the National Provider Identifier (NPI) of the certifying provider identified for a therapy plan of care must be included on the therapy claim.

Also addressed in the transmittal is the temporary application of therapy caps to outpatient Part B therapy services furnished in outpatient hospitals other than Critical Access Hospitals on/after October 1, 2012 and on/before December 31, 2012.

To see the full transmittal, click here.

Extension of Therapy Cap Exceptions Process

According to the Centers for Medicare & Medicaid Services (CMS), on March 23, 2010, President Obama signed into law the Patient Protection and Affordable Care Act, which extends the exceptions process for outpatient therapy caps (see Section 3103).  Outpatient therapy service providers may continue to submit claims with the KX modifier, when an exception is appropriate, for services furnished on or after January 1, 2010, through December 31, 2010.  

The therapy caps are determined on a calendar year basis, so all patients began a new cap year on January 1, 2010.  For physical therapy and speech language pathology services combined, the limit on incurred expenses is $1,860.  For occupational therapy services, the limit is $1,860.  Deductible and coinsurance amounts applied to therapy services count toward the amount accrued before a cap is reached.