decisionhealth Newsletters, Part B News - 2012 Issue 9 (September)
Avoid denials by understanding CMS’ therapy cap changes that start Oct. 1
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Article Overview
This article explains upcoming CMS changes to Medicare therapy cap processing and the phased start of manual medical review across Medicare administrative contractors. It is aimed at therapy providers and billing staff who need to understand threshold tracking, advance request timing, claim submission requirements, and related Medicare documentation steps to help avoid denials.
Why This Topic Matters
The changes affect when therapy claims may be reviewed, delayed, or denied, so practices need to understand the transition dates and administrative requirements to maintain payment flow and reduce denials.
Article Sections
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Denials management
Introduces the policy change timeline, the role of Medicare administrative contractors, and the general impact on claims processing for therapy services.
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Billing scenarios for patients above $3,700 cap
Outlines several general ways practices may handle claims when patients are above the therapy threshold and services are needed promptly.
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2 tips to get paid under new cap rules
Summarizes practical administrative steps for checking patient accrual toward therapy limits and ensuring claim records include required information.
What You Will Learn
- How the therapy cap changes affect Medicare payment processing
- How the manual medical review rollout is timed across contractors
- What administrative steps practices may need to take when patients exceed the therapy threshold
- How providers can verify therapy accrual and prepare claims documentation
Who Should Read This
- Therapy providers
- Physical therapy practices
- Occupational therapy practices
- Speech-language pathology billing staff
- Medicare billing and reimbursement staff
- Practice administrators
Modifiers Discussed
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