As more Medicare beneficiaries choose to switch their medical coverage from traditional Medicare to Medicare Advantage plans (31% in 2015), I receive more and more questions regarding do the outpatient therapy rules and regulations that apply to traditional Medicare also apply to the Medicare Advantage plans. In this article, I will answer the following questions:
- Do Medicare Advantage plans have an annual therapy cap?
- Do Medicare Advantage plans provide the same coverage as traditional Medicare?
- Must Medicare Advantage plans follow National Coverage Decision and Local Coverage Decision policies?
- If a service in not covered by the Medicare Advantage plan, must I issue an Advance Beneficiary Notice of Noncoverage (ABN)?
- For Medicare Advantage plans, must a physician sign and date (ie. certify) my therapy plan of care?
- Do Medicare Advantage plans require functional limitation reporting?
- If I am not a provider with a Medicare Advantage plan, can I see the patient and collect cash for therapy services that would be covered by the Medicare Advantage plan?
- Do Medicare Advantage plans use the National Correct Coding Initiative Edits and modifier 59?
Do Medicare Advantage plans have an annual therapy cap?
All material posted on our website is the intellectual property of Gawenda Seminars & Consulting, Inc. and can’t be used, reproduced, or posted as your own material without the prior written approval of Gawenda Seminars & Consulting, Inc.
This article is not intended to and does not serve as legal advice or as consultative services, but is for general information purposes only.