decisionhealth Newsletters, Coder Pink Sheets - 2012 Issue 9 (September)
Avoid denials by understanding CMS’ therapy cap changes that start Oct. 1
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Article Overview
This article covers CMS and Medicare contractor guidance on upcoming therapy cap changes, including phased manual medical review implementation, threshold tracking, advance review requests, patient notice considerations, and claim submission requirements. It is relevant to therapy practices and billing staff who need to understand how the new rules affect payment timing, documentation, and contractor communication.
Why This Topic Matters
Therapy providers may face claim denials or payment delays if they do not follow the new Medicare review process and submission requirements tied to the updated therapy threshold. Understanding the transition timeline and contractor procedures helps practices prepare for uninterrupted billing.
What You Will Learn
- How the Medicare therapy cap changes are being phased in
- What manual medical review means for therapy claims above the threshold
- What types of advance notice and patient acknowledgment may be relevant
- How practices can check accumulated therapy amounts through contractor resources
- What claim information is emphasized for payment processing under the new rules
Who Should Read This
- Physical therapy practices
- Occupational therapy providers
- Speech-language pathology providers
- Medical billing staff
- Revenue cycle professionals
- Medicare compliance staff
Codes Discussed
Modifiers Discussed
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