Current News



Hospitals To Be Fined For Readmissions

As of October 1, 2012, Medicare will start fining hospitals that have too many patients readmitted within 30 days of discharge due to complications. The penalties are part of a broader push under President Barack Obama’s health care law to improve quality while also trying to save taxpayers money. To read the full story from USA Today, click…

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MedPAC Recommends Changes to Outpatient Therapy

The Medicare Payment Advisory Commission today discussed draft recommendations for reforming the Medicare benefit for outpatient physical and occupational therapy and speech-language pathology to control spending while improving care and access to services. Proposals include…

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MedPAC Recommends Changes to Outpatient Therapy Payment

The Medicare Payment Advisory Commission (MedPAC), on November 1, 2012, unanimously voted to recommend changes to reform the Medicare benefit for outpatient physical and occupational therapy and speech-language pathology. The final recommendations include…

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Manual Medical Review Updates

Please log in to see valuable information per your Medicare contractor for the manual medical review process.

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Manual Medical Review Forms

Below you will find the various Medicare contractors and links to their respective Manual Medical Review and Advance Exception Request web page and applicable forms and documents. In addition, many of the sites inform providers of various systems to track the therapy cap.

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CMS Therapy Cap & Manual Medical Review Documents

Over the past several weeks, the Centers for Medicare & Medicare Services has released several transmittals, MedLearn Matters Article, a Fact Sheet and a Q&A document all pertaining to the therapy cap and manual medical review process. I have combined multiple news articles to include all the documents here.

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Manual Medical Review of Therapy Services

The Centers for Medicare & Medicaid Services (CMS) released transmittal 1117 on August 31, 2012 and was replaced by transmittal 1124 on September 24, 2012 that details what must be submitted when requesting an advance exception to the $3700 therapy cap threshold as well as guidelines the Medicare contractors must adhere to when an exception has been made by a provider. Transmittal 1124 can be accessed by clicking…

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Therapy Cap Update From CMS

On August 31, 2012, the Centers for Medicare & Medicaid (CMS) released transmittal 2537 that provides new and additional information regarding the 2012 therapy cap and the manual medical review process scheduled for implementation on October 1, 2012. Transmittal 2537 also provides information on where to place the certifying physician/NPP NPI number on the claim form for both private practices and non-private practices. In addition, CMS will be holding an open door forum on September 5, 2012 from 2:00PM – 3:30PM eastern time on the manual medical review of therapy claims. The call in number is 1-877-251-0301; Conference ID: 23782155.

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