On March 21, 2013, the Centers for Medicare and Medicaid Services (CMS) released additional guidance on manual medical review for outpatient therapy services exceeding $3,700 in calendar year 2013. This applies to all Part B outpatient therapy settings except critical access hospitals. Medicare Administrative Contractors (MACs) will conduct prepayment review on claims reaching the $3,700 threshold with dates of service January 1, 2013 to March 31, 2013.  CMS requested MACs conduct these manual medical reviews within 10 days. At this time, there is no advance request for an exception process. Effective April 1, 2013, the Recovery Auditors will conduct review

On February 21, 2013, the Centers for Medicare and Medicaid Services (CMS) clarified the manual medical review process for 2013 and the application of the therapy cap as it applies to critical access hospitals. In 2013, Medicare Administrative Contractors (MACs) will conduct

The Centers for Medicare and Medicaid Services has informed the American Physical Therapy Association and the American Hospital Association that critical access hospitals (CAHs) will not be under the therapy cap. However, therapy furnished in the outpatient department of a CAH will be applied to the therapy cap dollar threshold for all other outpatient therapy settings.