decisionhealth Newsletters, Part B News - 2013 Issue 6 (June)
Benchmark: Don’t charge patients who exceed therapy cap without signed ABN
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Article Overview
This article reviews Medicare therapy billing issues tied to the annual therapy payment cap and the handling of denied claims. It is aimed at providers and billing staff who submit therapy services under Medicare and need to understand the reporting and liability implications described by CMS and related legislation. The piece also discusses the Medicare contractor remittance advice issue and why advance beneficiary notices matter when cap-related denials occur.
Why This Topic Matters
The article helps billing and compliance staff recognize when therapy claims may be denied under Medicare, how liability is reported, and why patient billing practices must align with the current guidance. It is relevant for avoiding improper patient charges and for understanding changes affecting claim denial handling.
What You Will Learn
- How Medicare therapy cap denials affect payment liability
- Why remittance advice reporting matters for therapy claim denials
- When advance beneficiary notices are relevant to therapy services
- How recent legislative and CMS guidance affects provider billing practices
Who Should Read This
- Medical coders
- Billing staff
- Practice managers
- Compliance staff
- Therapy providers
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