Tuesday, November 12, 2013

Access to Care is Being Threatened: Tell Congress to Fix Therapy Review Process

Medicare Part B therapy services enable patients to maintain their highest level of functional independence following an illness or injury, but unless Congress acts, beneficiaries are at risk of losing this key source of funding.
As part of the 2012 therapy cap extension, Congress called for Centers for Medicare and Medicaid Services (CMS) to institute a new review for claims which crossed an arbitrary cost threshold.

Though Congress intended for the manual medical review (MMR) process to be completed within a ten day window, due to administrative glitches, the opposite occurred. Members of Congress on the Senate Finance, House Ways & Means, and House Energy & Commerce Committees can solve this problem.  If your members of Congress serve on any of these Committees, then please contact them today and tell them to fix the MMR by:

  • Protecting beneficiary access from care disruptions by strengthening the ten day MMR requirement.

  • Improving the MMR process through simplification, standardization, and automation of contractor and provider communications.

  • Requiring a GAO analysis of the MMR process to identify opportunities to better design and tailor the Part B therapy benefit, and to improve the MMR process to better target medical review of outliers.
Finally, until an appropriate patient-centered alternative payment model for Part B therapy services is implemented, AHCA supports a Congressional extension of the current Part B therapy cap exceptions process, along with necessary safeguards to prevent against inappropriate therapy utilization.

Time is short for any legislative action, so please contact your Member of Congress today.

Remember, Alerts may only be set to those members of Congress serving on one of the three aforementioned relevant Committees. 

For more information, see our issue brief here, or contact Drew Thies at dthies@ahca.org or (202) 898-2816.

1 comment:

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