CMS policy change could mean PT audits for unwary orthopedists

Why This Topic Matters

The change affects how therapy-related Medicare claims are submitted and documented, and it may increase audit attention when exception billing is used. Practices that manage therapy services need to understand the policy context so they can support claims appropriately.

Article Sections

1. Policy change and audit concern

   Introduces the Medicare policy update and the concern that it may prompt closer review of therapy exception claims. It also frames the issue for orthopedic practices and therapy billing workflows.

2. Cap exceptions continue in 2007

   Summarizes the continuation of Medicare therapy cap exceptions for the year and explains the general policy background. This section also references the related federal law and the annual cap context.

3. How the therapy cap exception billing worked until now

   Describes the prior exception billing framework and the distinction between the types of exception handling used before the policy change. It also notes the shift in how claims are processed.

4. Documentation you’ll need to satisfy your carrier

   Focuses on the need for supporting records, ongoing reassessment, and clear documentation of therapy progress and goals. It discusses the kinds of patient circumstances that can complicate therapy planning.

5. Snapshot: Therapy Cap Exception Rule Change

   Provides a side-by-side summary of the policy change and the related carrier review emphasis. It offers a concise overview of the before-and-after framework.

6. Further Resources

   Lists related CMS transmittals and supporting materials referenced by the article. This section points readers to additional source documents.