Monday, March 24, 2014

Latest on Part B Therapy MMR

Dan Ciolek

Check out our previous blog on the exceptions process for Medicare Part B therapy caps possibly expiring on April 1.

AHCA has discussed the status of the Medicare Part B therapy manual medical review (MMR) program with an official at the Centers for Medicare and Medicaid Services (CMS). Based on this conversation, we suggest that SNF operators and therapists consider how to manage and store the documentation associated with therapy MMR eligible claims being paid during the current RAC review ‘pause.’ For care centers, this advance work may ease the burden of having to locate and prepare therapy MMR “additional development request” (ADR) responses once the ‘pause’ ends and reviews resume.

In other news, though details cannot yet be finalized pending Congressional action, CMS shared where it is leaning if Congress extends the requirement to review all therapy claims above the annual $3,700 threshold for physical therapy (PT) and speech-language pathology (SLP) services combined, or occupational therapy (OT) services. That information is in three topic areas, all of which is further discussed on AHCA's MMR webpage:
  1. Claims Processing and MMR ADR Generation Activities
  2. RAC Contractor Procurement
  3. CMS Provider Education
AHCA staff and members continue to work with Congress to pass legislation that would ease the burden imposed by the current therapy MMR requirement. We also continue working to educate CMS regarding our therapy MMR concerns so that future policy decisions are reasonable. Please contact AHCA's Dan Ciolek if you have questions.

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