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News & Press: Regulations & Policy

CMS Provides Partial Summary of Bipartisan Budget Act of 2018

Thursday, March 8, 2018   (0 Comments)
Posted by: Robin Childers
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If you provide Part B services in the home, you are likely anxiously waiting for clarification from the Centers for Medicare & Medicaid Services (CMS) about how claims affected by the outpatient therapy cap BEFORE signing of the Bipartisan Budget Act of 2018 will be handled.

Ellen R. Strunk, PT, MS, GCS, CEEAA, CHC, President and Principal Consultant for Rehab Resources and Consulting, Inc. has provided the following recap about what we know right now:

  • Medicare claims are no longer subject the therapy caps
  • Claims for therapy services above a certain amount of incurred expenses must include the KX modifier which indicates services remain medically necessary AND are justified by appropriate documentation in the medical record. This amount for 2018 is $2,010.
  • Claims for therapy services are subject to targeted medical review. This amount for 2018 is $3,000.
  • CMS will begin the process of releasing claims that had been held briefly after expiration of the therapy caps exception process. CMS will instruct the MACs to release for processing the held claims based on the date the claim was received. - e.g. first-in, first-out basis. Apparently MACs are restricted by the volume of claims they can release on a given day.

SOME of the provisions of the BBA of 2018 are summarized here.

APTA's Insider Intel Highlights and Recording on the Medicare Therapy Cap webinar from Feb. 15, 2018 is here (you'll need to install Adobe Connect).

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