Beginning in 2013, outpatient therapy services provided in CAH settings should be included in the beneficiary’s therapy cap and threshold total, using the amount that would be payable if the services were paid under the Medicare Physician Fee Schedule. Payments for outpatient hospital therapy services include a multiple procedure payment reduction when more than one unit or procedure is provided to the same patient on the same day by the same provider. Inadvertently, Medicare’s initial implementation of this provision updated the therapy cap and threshold total by the full fee schedule amount, without applying the multiple procedure payment reduction. The requirements of CR8278 correct how CAH claims update the therapy cap and threshold total.
Oregon Gov John Kitzhaber signed House Bill 2684 into law on May 9, 2013 that eliminates the 60-day time restriction tied to treatment for services provided by a physical therapist without a physician referral, granting unrestricted patient access to the services of a physical therapist. The legislation will take effect on January 1, 2014.
On May 1, 2013, the Centers for Medicare and Medicaid Services released a new Frequently Asked Questions (FAQ) document on Advance Beneficiary Notice of Noncoverage for outpatient therapy services for both below and above the therapy cap dollar threshold. To access the document, click
Beginning June 1, 2013, Aetna will no longer reimburse separately for
On March 15, the Medicare Payment Advisory Commission (MedPAC) issued its annual report to Congress. Chapters of interest include the following:
Chapter 4: Physician and other health professionals
Chapter 8: Skilled nursing facility services
Chapter 9: Home health services
Chapter 10: Inpatient rehabilitation facility services
At the end of each Chapter, MedPAC provides recommendations how Medicare payments should change in 2014 in each one of the settings listed above.
Senate Bill 277 was signed into law by Gov Mike Beebe on March 14, 2013. As a result, patients now will pay less out of their own pockets when they visit a PT, OT, and/or SLP, resulting in improved access to vital health care. SB 277 specifies that patient copays, coinsurance, and office visit deductibles charged by health benefit plans for services provided by physical therapists, occupational therapists, and speech language pathologists may not be higher than those charged for services provided by primary care physicians. SB 277 will take effect 90 days after the legislature adjourns.