Therapy Caps 2007

Update to 2006 Therapy Cap Regulations

Medicare has published new rules for the therapy caps exceptions process for 2007.  The key element of change is the elimination of the manual exceptions process.  The "automatic process" can be used to allow physical therapists and occupational therapists to provide patients with medically necessary above and beyond the $1780 financial limitation for 2007.

 

NEMB vs. ABN Forms

Should you determine that the patient does not qualify for an exception to the therapy caps, and additional therapy provided beyond the caps may not qualify as 'medically necessary' the proper form to use is the NEMB.

The Advance Beneficiary Notice (ABN) is a written notice which a physician or supplier gives to a Medicare beneficiary. The purpose of the ABN is to inform a beneficiary before he or she receives specified items or services that otherwise might be paid for by Medicare that Medicare probably will not pay for them for that particular beneficiary on that particular occasion. The ABN allows the beneficiary to make an informed consumer decision whether or not to receive the items or services for which he or she may have to pay out of pocket or through other insurance. (source MLN; ABN Readers)

quick links

10-6-2008: CMS Announces New Recovery Audit Contractors (RACs)

10-4-2008: OIG Releases New Rehab Fraud Case.

10-1-2008:  OIG Issues 2009 Work Plan:  Private practice therapy is identified.