Medicare Payments, Therapy Caps Set Through 2012.
by Ingrida Lusis
Legislation passed in late February averts a 27.4% reduction in Medicare fee schedule rates and extends the Medicare therapy cap exceptions process, both through 2012.
The provisions were included in the Middle Class Tax Relief and Job Creation Act of 2012. The legislation extends the fee schedule that had been in place for the first two months of 2012.
The extension of the therapy cap exceptions process—which allows Medicare beneficiaries to receive speech-language and physical therapy services beyond an $1,880 limit—includes additional safeguards to ensure that only medically necessary services above the cap are permitted:
- The use of the National Provider Identification number (NPI) of the physician reviewing the need for treatment.
- The continued use of the “KX” modifier on claims above the cap.
- A required manual medical review when expenditures reach $3,700 (combined physical therapy and speech-language treatment) for services furnished on or after Oct. 1, 2012.
- Temporary application of the therapy caps to hospital outpatient departments for services provided from Oct. 1 through Dec. 31, 2012.
(Click link above for more)
Therapy whistleblower suit allowed to proceed in MN – McKnight’s Long Term Care News. – An occupational therapy assistant will be able to move forward with a lawsuit against her former employer over what she says were fraudulent therapy claims.(click link above for more)
Details of SGR deal released – Healthcare business news and research | Modern Healthcare.
By Jessica Zigmond
Posted: February 16, 2012 – 4:30 pm ET
Federal lawmakers on Thursday agreed on a payroll tax holiday bill that would prevent a 27.4% cut in Medicare physician payment rates scheduled for March 1 and would freeze current payment rates through Dec. 31, 2012. The provision also requires that the Government Accountability Office and HHS submit reports to help Congress develop a long-term replacement of the existing Medicare physician payment system. (click link above for more)
AQNHC: CMS Rule Phase-In, No Additional SNF Cuts Critical to Preserving Quality Patient Care, Preventing More Direct Care Job Losses – PR Newswire – sacbee.com. – WASHINGTON, Feb. 15, 2012 — At Senate Finance Committee Hearing on FY 2013 Budget, Alliance for Quality Nursing Home Care Says U.S. Nursing Homes Slated to Absorb $127 Billion in
Medicare Reductions Between FY 2012-21
WASHINGTON, Feb. 15, 2012 /PRNewswire-USNewswire/ — With America’s skilled nursing facility (SNF) sector already slated to absorb $127 billion in Medicare reductions between FY 2012-21, the Alliance for Quality Nursing Home Care said concurrent to today’s Senate Finance Committee hearing on the proposed FY 2013 budget that a phase-in of a 2011 Medicare regulation that reduced Medicare funding by 11.1 percent is critical to preserving quality nursing home care, and preventing additional facility job losses. (click link above for more)
Coalition to Congress: Protect Seniors By Protecting Therapy Services — WASHINGTON, Feb. 15, 2012 /PRNewswire-USNewswire/ —. – Coalition highlights importance of extending therapy caps –
WASHINGTON, Feb. 15, 2012 /PRNewswire-USNewswire/ — Advocating on behalf of hundreds of thousands of Medicare beneficiaries who receive outpatient rehabilitation services every year, the Therapy Cap Coalition on Feb. 14 urged members of the Congressional Conference Committee to show their love to seniors this Valentine’s Day by providing the longest possible exceptions extension for Medicare Part B therapy services in the Committee’s final agreement. (click link for more)
Therapy cap exceptions process must be extended, advocates urge – McKnight’s Long Term Care News. Members of a Congressional conference committee need to authorize the longest possible exceptions extension for Medicare Part B therapy services, according to a coalition of therapy advocates. (click link for more)
Last night, the House of Representatives passed HR 3630 “The Middle Class Tax Relief and Job Creation Act of 2011” by a vote of 234 to 193. The bill contains many provisions including a payroll tax cut, the Keystone oil pipeline, a fix of the SGR cut for two years therefore stabilizing the physician fee schedule, and a two year extension of the therapy cap exceptions process. The exceptions process is modified in two ways. First, the bill adds a layer of review once therapy costs reach $3,700 for PT and SLP and $3,700 for OT (we do not know yet the details of this review). Second, the NPI of the physician reviewing the therapy plan of care must be included on the claim.
The bill has to be paid for according to House rules. The extension of the exceptions process is paid for by including hospital outpatient therapy under the therapy cap. There are significant cuts to hospitals in the bill. Nursing homes are subject to a phase down of their ability to get reimbursement for bad debt. In addition to all of this, the President has said he would veto the House bill if it was sent to him in this form.
The action now turns to the Senate. Conversations with Senate Finance staffers this morning revealed that action on the Senate bill could extend to late next week. The Senate could draft a very different bill with a different approach to the exceptions process including a one year extension of the exceptions process. We support a two year extension with a clean exceptions process just as it is now. Continued grassroots communications with your Senators is necessary to keep the pressure on the Senate to deal with this issue before December 31st!
Your Advocacy Voice for Quality in Long Term and Post Acute Care – http://www.NASL.org via Article Details.