decisionhealth Newsletters, Answer Books - 2008 Issue 12 (December)
Answer_Book / Occupational_and_Physical_Therapists / Use_NEMB_for_patients_who_may_exceed_cap
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Article Overview
This Find-A-Code article is a brief Medicare billing guidance piece for physical therapists, occupational therapists, and coding/billing staff. It focuses on beneficiary notice use when therapy services may go beyond a Medicare cap, the general circumstances under which one notice form is preferred over another, and the provider’s role in informing patients about coverage status and financial responsibility. The article also mentions a related site of service option for continuing care after the cap is reached.
Why This Topic Matters
Therapy practices need to use the correct Medicare beneficiary notice when services are no longer covered under the cap. Understanding the topic helps staff communicate coverage limitations clearly and avoid using the wrong form in a noncovered scenario.
What You Will Learn
- How Medicare beneficiary notices relate to therapy cap situations
- The general distinction between a Notice of Exclusion of Medicare Benefits and an Advance Beneficiary Notice in this context
- Provider responsibilities for patient communication when therapy services may exceed coverage limits
- The relevance of outpatient hospital departments as an alternative setting for continued services
Who Should Read This
- Physical therapists
- Occupational therapists
- Speech-language pathology billing staff
- Medical coders
- Medical billers
- Practice administrators
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