doc fix

Late Tuesday night, the U.S. Senate overwhelmingly passed (92-8) a permanent “Doc Fix” – officially known as the Medicare Access and CHIP Reauthorization Act of 2015. This comes on the heels of the House passing the same bill with strong bipartisan support late last month. Now, with the President indicating he will quickly sign the measure, the bill will soon become law.

While much of the media coverage of this important legislation has centered around the repeal of the onerous “Sustainable Growth Rate” for physician payments and prevention of a 21% cut in Medicare payments to physicians effective April 1, 2015, the bill also included important therapy-related provisions.

Extension of the Medicare Part B Therapy Cap Exceptions Process
As you know, since 2006 we have had an exceptions process in place so that we can continue to provide medically necessary rehabilitative therapies above and beyond the arbitrary “therapy cap.” Through Congress’ action, the exceptions process is extended through December 31, 2017. Without this legislation, an annual $1,940 cap on occupational therapies and a joint $1,940 cap on physical and speech therapy services would have gone into effect on April 1.

This extension of the exception process provides necessary relief from the arbitrary cap and creates more time to advance sensible policies to repeal the onerous caps.

Medicare Medical Manual Review (MMR) Relief
Since 2014, when Congress imposed the Medical Manual Review (MMR) process for Medicare Part B claims exceeding $3,700 in one year, the program has been fraught with challenges. After extensive education and lobbying of Members of Congress and their staff as to the many problems with the MMR policy, we are proud to share that the “Doc Fix” included targeted MMR relief.

Specifically, under the MMR relief, reviews will be more appropriately targeted toward providers that meet the following criteria: 1) high claims denial percentage, 2) aberrant billing patterns, 3) newly enrolled in Medicare, 4) furnish services to treat a type of medical condition, and 5) are part of a group that includes another therapy provider identified by these criteria.

Part B Payment Stability for Therapy Services
As you know, the Medicare payments for the Part B services our therapists provide are tied to the Physician Fee Schedule. With the replacement of the troubled SGR, the passed legislation establishes a schedule of steady positive updates to Part B therapy payments. This stability is welcome after the series of 17 short-term patches that we have experienced since 2006.