Navigating the murky waters of Medicare can be as scary as finding yourself on —well, maybe not just as scary, especially if you have WebPT to help. We’re filling this month’s blogs with all sorts of valuable and applicable information on everything there is to know about 2013 Medicare. But what better way to get up to speed than with some frequently asked questions. What is the Therapy Cap?

Under the Balanced Budget Act (BBA) of 1997, Congress placed an annual cap on rehabilitation services through Medicare. That means that Medicare will only reimburse you as the rehabilitation therapist up to a certain dollar amount per patient regardless of services provided. Ce Freza Mi Se Potriveste Program.

In 2013, CMS increased the therapy cap by $20 to $1,900 (from $1,880 in 2012) for physical therapy and speech therapy combined and $1,900 for occupational therapy. Slrr Engine Tool Modification here. This year, the therapy cap applies to services furnished in private practice, physician offices, skilled nursing facilities (Part B), rehabilitation agencies (or ORFs), comprehensive outpatient rehabilitation facilities (CORFs), and outpatient hospital departments. Unless Congress passes legislation, the therapy cap will no longer apply to outpatient hospital settings beginning January 1, 2014.

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What is the KX Modifier? When your patient qualifies for a therapy cap exception, simply add the KX modifier to the therapy procedure code that is subject to the cap limits. You can find eligible therapy procedure codes within Chapter 5, Section 20(B), 'Applicable Outpatient Rehabilitation Healthcare Common Procedure Coding System (HCPCS) Codes” of the Claims Processing Manual. By attaching the KX modifier, you are attesting that the services billed: • Qualify for the cap exception; • Are reasonable and necessary services that require the skills of a therapist; • And are justified by appropriate documentation within the medical record. You are not required to provide any special documentation in your automatic process exception request as long as your patient does, in fact, meet the necessary conditions. However, if Medicare has any additional questions regarding your patient’s qualifications, you may receive an Additional Documentation Request (ADR) to which you are obligated to respond with documentation justifying the services you performed.

What is the Medicare Allowable Fee Schedule? According to the, a fee schedule is a “complete listing of fees used by Medicare to pay doctors or other providers/suppliers. This comprehensive listing of fee maximums is used to reimburse a physician and/or other providers on a fee-for-service basis. Cthulhu Investigators Companion Pdf Download.

CMS develops fee schedules for physicians, ambulance services, clinical laboratory services, and durable medical equipment, prosthetics, orthotics, and supplies.” This year, you can enter your Medicare allowable fee schedule within WebPT and we’ll automatically track your patients progress towards the therapy cap. The fee schedule is available now, and the alerts for tracking will be available later this month. If my clinic doesn’t accept Medicare, can I treat Medicare patients? According to (), “What I learned through research is that if you don’t accept Medicare, you can’t treat Medicare patients. It’s illegal to accept cash payments from Medicare patients for physical therapy (see Section 40 of the ).