• The 2015 Therapy Cap: Same Story, Different Year Image

    articleNov 18, 2014 | 3 min. read

    The 2015 Therapy Cap: Same Story, Different Year

    With all of the blog space we’ve devoted to PQRS this month, it’s easy to forget that Medicare’s final rule addresses more than just our favorite four-letter acronym. But buried deep within CMS’s annual 1,000-plus-page behemoth of government jargon is one more major item of interest to those in the PT, OT, and SLP industries: the therapy cap. First, the good news: in accordance with the Medicare Economic Index (MEI), both cap amounts—the one for occupational therapy …

  • Final Rule 2015: Here’s What You Need to Know Image

    articleNov 6, 2014 | 3 min. read

    Final Rule 2015: Here’s What You Need to Know

    The summary of this year’s Final Rule is hot off the presses, which means that—among other things—we now know the details regarding PQRS 2015. For those who have been following the PQRS saga since the program first came into being in 2007, it should come as no surprise that Medicare has yet again upped the ante for compliance. Based on the fact sheet CMS provided , here’s the scoop on this year’s reporting requirements: Eligible professionals who …

  • Common Questions from our Modifier Open Forum Image

    articleJul 7, 2014 | 10 min. read

    Common Questions from our Modifier Open Forum

    Should I have my patients sign an advance beneficiary notice of noncoverage (ABN) just in case Medicare doesn’t pay? No, by having your patient sign an ABN, you are acknowledging that you do not believe that the services you are providing are either medically necessary or covered by Medicare. If you have an ABN on file, you should include a modifier GA or GX modifier on your claim so Medicare knows to deny the claim and assign …

  • This Week in PT News, March 28 Image

    articleMar 28, 2014 | 2 min. read

    This Week in PT News, March 28

    S. 2110 Vote The Senate is scheduled to vote on the Medicare cap this week, so it’s your last chance to contact your local representatives and ask them to vote “yes” for the Medicare SGR Repeal and Beneficiary Access Improvement Act (S. 2110). Find your senator’s contact information here . HR 4302 Vote Yesterday, the House of Representatives passed by voice vote a proposal (HR 4302) to delay for 12 months a scheduled 24% cut to Medicare …

  • Act Now: The Therapy Cap Exceptions Process Expires March 31 Image

    articleMar 13, 2014 | 5 min. read

    Act Now: The Therapy Cap Exceptions Process Expires March 31

    For years, rehab therapists have had a love-hate relationship with Medicare’s therapy cap exceptions process. On the one hand, therapists often see it as a barrier to providing patients with the care they need; on the other, it’s the only means for therapists to continue treatment after a Medicare patient has exhausted his or her annual payment allotment for therapy services (a.k.a.  the therapy cap ). Reform of the cap has been a long time coming, and …

  • The Great Medically Necessary Discussion and How to Use ABNs Image

    articleMar 12, 2014 | 6 min. read

    The Great Medically Necessary Discussion and How to Use ABNs

    For many physical therapists, the phrase “medically necessary” sounds worse than nails on a chalkboard. On the one hand, it’s vague, subjective, and open to infinite interpretation. And on the other, it’s often the determining factor in whether payers—perhaps most notably, Medicare—will provide reimbursement for rehab therapy services. A Bit of History The history of the “medically necessary” reimbursement requirement stretches all the way back to the 1960s. As E. Haavi Morreim explains in  this article , it was …

  • Monitoring Your Clinic’s Medicare Compliance Within WebPT Image

    articleFeb 13, 2014 | 4 min. read

    Monitoring Your Clinic’s Medicare Compliance Within WebPT

    It appears we have a theme going this week. Brooke devoted  Monday  and  Tuesday  to discussing WebPT’s business reports. Yesterday, I showed you  the ins and outs of the Plan of Care Report . But monitoring your Medicare compliance doesn’t end there. Here are a few more helpful reports: Medicare Payment Adjustment Report (MPAR) The Medicare Payment Adjustment Report (MPAR) shows you how multiple procedure payment reductions (MPPR) are affecting your clinic’s profits and losses. Most practice …

  • webinarNov 26, 2013

    PQRS and All Things Medicare Compliance

    In November, we hosted a webinar focused on PQRS and other Medicare regulations. This session covered an array of Medicare regulations, including: The basics of functional limitation reporting, the therapy cap, and PQRS How the 8-minute rule works How you can get involved with the APTA’s #stopthetherapycap initiative

  • articleNov 20, 2013 | 3 min. read

    Get Involved: Help the APTA #StopTheTherapyCap

    In 1997, Congress passed the Balanced Budget Act, which led to the creation of the sustainable growth rate reform (SGR) formula as well as the Medicare therapy cap. According to the APTA —and Congress—these measures were meant to save money. However, there are some serious flaws in both. As a result, every year, Congress has acted to address said flaws and stop the implementation of a hard cap. (For more information on the therapy cap and how …

  • articleNov 19, 2013 | 4 min. read

    Therapy Cap Recap

    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 …

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