Health reform law extends therapy exemptions, shortens claims filing deadline

Why This Topic Matters

The changes described affect claim submission timing, payment calculations, therapy exception billing, and other operational areas that can influence compliance and reimbursement for Medicare-participating practices.

Article Sections

1. CMS implementation overview

   General background on CMS implementation of selected PPACA provisions and the timing of related system changes.

2. Therapy cap exceptions process extended (Sec. 3103)

   Coverage of the extension related to outpatient therapy claims and the broader therapy payment context.

3. New timely filing deadline for claims (Sec. 6404)

   Discussion of the revised Medicare claims filing timeframe and the interim phase-in schedule.

4. Overpayments must be repaid sooner (Sec. 6402)

   Summary of the shortened overpayment reporting and return timeline and associated compliance implications.

5. The work geographic index floor extended and the practice expense geographic adjustment revised under the Medicare physician fee schedule (Sec. 3102)

   Description of physician fee schedule geographic adjustments and related methodology changes.

6. CMS will continue to review misvalued codes under the physician fee schedule (Sec. 3134)

   Overview of ongoing review authority for physician fee schedule valuation and rate adjustments.

7. Payment for bone density tests (Sec. 3111)

   Discussion of Medicare payment changes for selected diagnostic services over a defined period.

8. Presumed utilization rate increases for high-cost imaging equipment (Sec. 3135)

   Coverage of imaging payment methodology changes and the schedule for phased adjustments.

9. PQRI changes (Secs. 3002, 3003 and 3007)

   Summary of updates to the quality reporting program, incentives, reporting, and future payment adjustments.

10. Limitation on Medicare exception to the prohibition on certain physician referrals for hospitals (Sec. 6001)

    Overview of Medicare participation restrictions affecting physician-owned hospitals and related requirements.

11. A new independent payment advisory board (Sec. 3403)

    Description of the advisory board’s role, authority, and reporting framework within Medicare policy.

12. Contiguous body part discount rate to increase (Sec. 3135)

    Summary of an imaging payment adjustment affecting services performed on related body parts.

13. Self-referral disclosure (Sec. 6003)

    Discussion of an additional disclosure requirement tied to the Medicare in-office ancillary exception.