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Medicare Therapy Cap Exception

 
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Medicare Therapy Cap Exception - January 3, 2010 4:16:43 AM   
goodlooks58

 

Posts: 456
Joined: October 22, 2002
From: CA
Status: offline
Has the sky eventually fallen on private practise owners?! Jan1st we are loosing the Therapy cap exception. Hopspital outpatient is not affected. How come PTs on this chat group are not discussing this topic? Seems no one is distraught about this issue! Or are we the ostrich with our head in the sand?
Post #: 1
RE: Medicare Therapy Cap Exception - January 3, 2010 7:50:56 AM   
SJBird55

 

Posts: 3332
Joined: May 11, 2004
From: Michigan
Status: offline
Apparently, the reason it is in place is legislators did not believe including the exemption process was necessary because in their eyes it is highly unlikely anyone would eat up the cap from Jan to March.  I'm in agreement with them.  I have hardly ever had to use a KX modifier in that length of time.  So... I'm not getting my panties in a bundle over it.  

(in reply to goodlooks58)
Post #: 2
RE: Medicare Therapy Cap Exception - January 7, 2010 12:00:16 AM   
hmgross

 

Posts: 346
Joined: March 1, 2003
From: Minnesota
Status: offline
I'm with SJ really don't use the modifier much and certainly not before March!

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Holly Gross PT

(in reply to SJBird55)
Post #: 3
RE: Medicare Therapy Cap Exception - January 7, 2010 9:44:13 PM   
mhberk

 

Posts: 7
Joined: October 14, 2008
Status: offline
All of this is very new to me.  Is the cap for the entire year or is it just for the three month period?

(in reply to SJBird55)
Post #: 4
RE: Medicare Therapy Cap Exception - January 8, 2010 6:37:23 AM   
SJBird55

 

Posts: 3332
Joined: May 11, 2004
From: Michigan
Status: offline
I have one freak issue where I might need to use modifier... depends... she just started being treated for 2 body parts... that kind of thing can eat into the cap, potentially.

(in reply to mhberk)
Post #: 5
RE: Medicare Therapy Cap Exception - January 8, 2010 6:39:16 AM   
SJBird55

 

Posts: 3332
Joined: May 11, 2004
From: Michigan
Status: offline
How about a real issue that pisses me off... Currently all the claims sent to Medicare will just sit in a holding bin or something... just sit there until January 15th and then they will all get dumped into the system and begin getting processed.  Medicare isn't making any payments on claims submitted between now and January 15 until after the 15th.  In my eyes... that just isn't right.  We did the service and the payer should be trying to pay us as quickly as possible...

(in reply to SJBird55)
Post #: 6
RE: Medicare Therapy Cap Exception - January 9, 2010 11:22:32 AM   
hmgross

 

Posts: 346
Joined: March 1, 2003
From: Minnesota
Status: offline
In my first year in private practice (2005) I had a notice from medicare (WPS) that I payments would be held in accordance with their "balanced budget act" so something like that. I remember thinking--wow must be nice. I would like to tell the mortage company the same thing when my funds run a bit low, but I can't do that now, can I?? The cap frustrates the crap out of me. I have had patients see me late in the year, they had a big chunk of therapy somewhere else and I have nothing left. Try getting patients to understand that!

_____________________________

Holly Gross PT

(in reply to SJBird55)
Post #: 7
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