Wednesday, April 2, 2014

Part B Therapy Service Benefit Stabilized by Congress

Dan Ciolek

On April 1 the President signed into law the ‘Protecting Access to Medicare Act of 2014’ providing assurances for at least the next 12 months that Medicare beneficiaries may continue to receive medically necessary physical therapy, occupational therapy, and speech-language pathology services under the Part B benefit.

While AHCA was aggressively lobbying with numerous beneficiary and provider group coalition partners for permanently replacing the therapy caps with a more sensible patient-centered medical review and payment system, Congress was only able to agree to stabilize procedure payment rates, and add another one-year extension of the current therapy cap exceptions process and associated manual medical review (MMR) program.

In short, the provisions impacting Part B therapy services include:
  • The Medicare Physician Fee Schedule (MPFS) rates will remain unchanged through the remainder of 2014. Your charge masters need not change.
  • The MPFS rates for at least January through March 2015 will be established through rulemaking (around November) with a 0% Sustainable Growth Rate (SGR) adjustment. 
  • The therapy caps exceptions process is extended through March 31, 2015. You can continue to use exceptions to furnish necessary Part B therapy services above the $1,920 caps using usual procedures.
  • The associated MMR process is extended through March 31, 2015. Although CMS has currently ‘paused’ MMR reviews, and a resumption date has not been established yet, you should be prepared to respond to Additional Development Requests (ADRs) for ALL therapy services furnished beyond the $3,700 threshold since the ‘pause’ began in February. The Centers for Medicare and Medicaid Services (CMS) has indicted that they expect Recovery Audit contractors to conduct post-payment review on these claims once the MMR reviews resume. 
AHCA continues to advocate for a permanent replacement of the therapy caps before these provisions expire on March 31, 2015. We are also working with CMS to fix administrative problems with the MMR process and will provide updates as they occur.

No comments:

Post a Comment