Outpatient Rehabilitation Therapy Cap

1
Outpatient Rehab Therapy Cap

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  www.wbcindia.com

2
Therapy Cap

• Therapy caps are Medicare law which limits how
  much it pays for your medically necessary
  outpatient therapy services in one calendar year.
  
• The therapy cap is exception process for use of
  the KX modifier and the manual medical review
  (MMR) process.

3
Therapy Cap Updates

• Hospital OP Clinics are exempt from the therapy
  cap, they do NOT have to track against the limit
  of 2,010.
• Non-hospital-based outpatient therapy settings
  are NOT exempt from the therapy cap.
• All Medicare beneficiaries that exceed the 2,010
  amount in these settings will be statutorily
  responsible to pay the provider for any therapy
  services that exceed the therapy cap.

4
Latest Update from CMS

• CMS is committed to implementing the Medicare
  program in accordance with applicable laws and
  regulations, including timely claims processing.
• CMS will hold all newly received therapy claims
  with the KX modifier and implement a rolling
  hold.

5
What to do now?

• Try to minimize the touches you need to do for
  your Medicare Authorizations during this
  uncertainty period.
• Assure that if the therapy exception process is
  extended, the tracking of the therapy cap will
  not be interrupted.
• Continue to conduct business as if the therapy
  cap with KX modifier is in place.

6
Thank You

• 
  www.wbcindia.com