Are you prepared for new Medicare Part B outpatient therapy regulations?

Beginning on October 1, 2012, the Centers for Medicare and Medicaid Services (CMS) will enforce new Medicare Part B caps on therapy services provided in settings including hospital outpatient therapy departments.

Also new for us:

  • an additional “hard cap” for therapy services
  • a new medical manual review process for claims above the new cap
  • an exceptions process for medically necessary care

For 2012, the Part B caps are set at:

  • $1,880 per Medicare beneficiary for occupational therapy services
  • $1,880 for physical therapy and speech language pathology services combined

The exceptions process enables therapists to continue to provide services beyond the cap when they can chart and illustrate the need for continued medically necessary care.

A manual review process with the local designated Medicare Administrative Contractor will be done at:

  • $3,700 for physical therapy and speech language pathology combined
  • $3,700 for occupational therapy

This year, CMS warned those who may be nearing the $1,880 annual therapy cap that if they exceed it, even with an exception, they may have to pay costs above the cap. This threat is causing some patients to request discharge from therapy services, even though they continue to be medically necessary.

Therapists and physicians need to be well-versed regarding the therapy caps and the exceptions process to skillfully manage beneficiary and family concerns, tamp down any fear and explain the need for vital therapy services for recovery. These changes also underscore the need for accurate and effective documentation for every beneficiary.

Here are some tips for staying current on this issue.

  • Provide timely updates and reminders of best practices, such as protocols for effectively submitting claims, tips for appropriately coding therapy services and evaluations, and reminders about documenting the medical necessity of therapy.
  • Consider investing in counsel from a highly skilled rehab management partner who can navigate through the changes and quickly implement best practices and documentation updates to ensure that your hospital’s outpatient therapy department operates with maximum efficiency, effectiveness, and in compliance with new laws and regulations.

Will your department be prepared to comply with these regulations? Are your therapists ready to document to illustrate medically necessary rehabilitative care? Do you have the tools and resources to seamlessly and effectively communicate the changes to beneficiaries?

For more details, AMRPA members can download a pdf of the full version of this text from the AMRPA site:

By Kindred Hospital Rehabilitation Services