Medicare Part B therapy caps have been permanently repealed as part of the bipartisan budget deal passed last week and signed by President Trump on Friday, 2/9/18.
The repeal will be retroactive to January 1, 2018, but claims over $2010.00 (OT or PT/SLP combined) will continue to require the KX modifier as an attestation of medical necessity. As CMS implements the new law, more updates will become available.
Planned Medical Review of Funding Cuts
- Targeted Medical Review was restored under the spending package and will target a sample of claims exceeding $3,000 (vs the previous $3,700 threshold). In the past CMS has used a Supplemental Medical Review Contractor (SMRC) to conduct targeted medical review
- Part B therapy provided by PTA & COTA staff will be reduced to 85% of the fee schedule amount beginning 2022 (this does not impact reimbursement for Part A SNF PPS services furnished by PTA/COTAs – only Part B billing)
Proactive Medical Review is Here to Help. How?
- Remote medical record audits, MDS coding validation
- SNF Compliance Programs, Medical Review support