therapy cap Archives | WebPT

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Over the Line: 4 Times When It’s Okay to Treat a Medicare Patient Beyond the Therapy Threshold

The #spookyszn has come and gone, but for many physical therapists, the threat of a Medicare audit is far more frightening than any ghoul or goblin—no matter what time of year it is. As such, some PTs may try to subvert the ever-watchful eye of CMS by remaining cautious as their patients creep closer to the Medicare physical therapy threshold (formerly known as the “Medicare physical therapy cap”).

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CMS’s Final Bow: The 2019 Final Rule

Last week, the Centers for Medicare and Medicaid Services (CMS) published its 2019 final rule. Clocking in at just over 2,300 pages, the final rule isn’t exactly a light read—especially because the legal lingo can be harder to interpret than Shakespearean verse. Luckily, we have the script—with all its twists and turns—decoded and ready for you to review.

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When to Use the KX Modifier

In the months since the elimination of the hard cap on therapy services, it seems like rehab therapists are more confused than ever about when they should affix the KX modifier versus issue an Advance Beneficiary Notice of Noncoverage (ABN). The truth of the matter is that not much has changed operationally since the Medicare therapy cap repeal—aside from the name of the cap (i.e., what was once the “hard cap” is now called the “soft cap” or “threshold”).

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Cut the Cap: The Case for Eliminating Limits on Rehab Therapy Services

Let’s take a little trip to the past: the year was 1997. “Titanic” was smashing box office records as moviegoers flocked to theaters for their third or fourth viewing; “Wannabe” by Spice Girls was hitting the airwaves on every Top 40 station; and large-scale healthcare reform was barely stepping into the legislative limelight.

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Denial Management FAQ

During our denial management webinar, we discussed the difference between rejections and denials, explained how to handle both, and provided a five-step plan for stopping them in their tracks. The webinar concluded with an exhaustive Q&A, and we’ve amassed the most common questions here.

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