WebPT Blog - manual medical review
Nov 19, 2013| by Brooke Andrus
If you’re a rehab therapist who treats Medicare patients, you’ve got a bevy of rules and regulations to follow and knowing all of them inside and out is a tall order, to say the least. If decoding government legalese isn’t really your thing, don’t worry—we’ve dedicated this entire month to serving up a smorgasbord of digestible, easy-to-understand guides on the important Medicare policies that apply to you. On today’s menu: the therapy cap.
As part of the Balanced Budget Act (BBA) of 1997, the therapy cap places an annual limit on the total amount of reimbursement Medicare will provide for each patient’s rehabilitation services. In 2013, that amount was $1,900 (up $20 from $1,880 in 2012) for physical therapy and speech therapy combined, along with an additional $1,900 for occupational therapy. Although the government has yet to finalize the 2014 Physician Fee Schedule Rule—which will lay out the details of next year’s cap amount and the regulations surrounding it—we’re not expecting any major changes from last year’s therapy cap rules.
Here are some more fast facts about the therapy cap:
- It currently applies to services furnished in:
- private practices
- physician offices
- skilled nursing facilities (Part B)
- rehabilitation agencies (or ORFs)
- comprehensive outpatient rehabilitation facilities (CORFs)
- outpatient hospital departments—although it will no longer apply to outpatient hospital settings in 2014 unless Congress passes legislation
- It does not reset for each diagnosis.
- Examinations or re-examinations that establish the medical necessity of continuing treatment beyond the cap do not count toward the cap, even if the patient has already exceeded it. (But, if the patient receives treatment, the entire visit counts toward the cap).
- It currently applies to services furnished in:
Aug 28, 2013| by Heidi Jannenga PT
If you’re like most rehab therapists, finding a letter from Medicare in your mailbox is enough to make your brow sweat and your heart skip a beat. With all of the regulations we have to follow—and the potential penalties associated with noncompliance—it’s no surprise that we have grown to fear Medicare. We’re afraid of doing something wrong. Or in some cases, we’re afraid of not getting paid. Thus, rather than defend our decisions, our expertise, and our treatment plans, some of us look for ways to “game the system.” One way therapists are doing this is working around the therapy cap to avoid having their exceptions rejected.
In a recent article on RAC Monitor, compliance expert Nancy Beckley explains that there is yet another Centers for Medicare & Medicaid Services (CMS) review contractor scrutinizing outpatient therapy—specifically, in instances where treatment stopped “at or near the cap” and then started up again at the beginning of a new benefit period. This looks suspicious to CMS, and understandably so. In their eyes, stopping treatment means therapy is no longer “medically necessary.” So why would it suddenly become necessary again after the cap resets? To an auditor, the therapist in this type of scenario would appear to be working around the system. Medicare has rules, and those rules are there to protect the beneficiary and to ensure we give the proper justification for our services and the costs incurred. Sure, we didn’t create them. In fact, we didn’t even have much say in the matter (partly due to our industry’s historical lack of a strong, unified voice). Even so, we must follow them—no matter how inconvenient they may be.
Aug 28, 2012| by Charlotte Bohnett
Today's post comes from copywriters Erica Cohen and Charlotte Bohnett.
Last week WebPT hosted its most heavily attended webinar ever. Why so popular? Perhaps it was the brow-furrowing topic of compliance, or maybe it was our special guest—physical therapist and compliance expert Rick Gawenda of Gawenda Seminars. Together, Rick, moderator Mike Manheimer, and WebPT co-founder Heidi Jannenga, PT, set out to tackle compliance, making it entertaining, informative, and most importantly, understandable. Here’s a brief snapshot of what they discussed:
- What is compliance? How does it relate to Medicare and medical billing? And why should you care?
- What is the 2012 Therapy Cap?
- Modifiers and How to Use Them
- Manual Medical Review
- How does documenting with an EMR help you stay compliant?
- What is PQRS? How can you ensure compliance with outcome measures? What are the reporting methods?
Want the full kit and compliance kaboodle? Watch the webinar in its entirety below:CMS, compliance, emr, gawenda seminars, manual medical review, medical billing, medicare, modifiers, outcome measures, physical therapy, PQRS, PT best practices, rick gawenda, therapy cap, webinar
Aug 6, 2012| by Heidi Jannenga PT
Today’s blog post comes from WebPT cofounder and COO Heidi Jannenga, PT, MPT, ATC/L
To all of our Super Therapists working diligently to improve their patients’ functional level and quality of life, the Center for Medicare and Medicaid Services (CMS) has tossed a chunk of Kryptonite into our clinics.
As you know, CMS has implemented many changes this year and continues to have the Proposed Rule for prospective payment and data collection pending. Keeping up to date with these changes is crucial if you are treating patients with Medicare insurance. As our fellow superhero Spiderman says, “Whatever comes our way…we always have a choice...It's the choices that make us who we are, and we can always choose to do what's right.” As therapists, we want to do what’s right for our patients, and that means producing excellent documentation that aligns with Medicare’s compliance requirements. Our skillset as therapists includes validating the need for our services, and we can only achieve this through thorough documentation and use of tests and measures to help show progress during the episode of care. EMRs can help to enforce Medicare compliance, while improving workflow efficiency, but ultimately you’re the last line of defense.CMS, compliance, electronic billing, emr, insurance, insurance regulations, Mac, manual medical review, medicare, proposed rule, reimbursement, therapy cap