Posted on 04.16.15 by Cindy Hudson, B.S./OTR-L, CHC
Late Tuesday night on April 14, 2015, the Senate passed H.R.2, the Medicare Access and CHIP Reauthorization Act. The House already approved this bill back in March of this year and the President is expected to sign this bill into law quickly. Although the therapy cap exception process technically ended as of April 1, Medicare held therapy claims that would no longer qualify for the exception process (those with a KX modifier) with the expectation of this bill's passage into law.
This new law will now extend the therapy cap exception process until January 1, 2018. Under the new law there will also be a revision to the auditing process with a new targeted review procedure to replace the manual medical reviews. Details of the targeted reviews are yet to be disclosed. Unfortunately an ammendment proposed by Senator Ben Cardin (D-MD) to repeal the therapy caps altogether did fail, but only by 2 votes! This indicates growing support for finding a better way to provide ongoing quality therapy services for a vulnerable segment of our population.
Included with H.R.2 are provisions to avert a 21% pay cut to Medicare physician services as well as other Part B outpatient services. In addition, there is a six month delay for enforcement of CMS's “two midnights” payment policy for brief hospital stays.
In light of the targeted reviews to be initiated by CMS, as well as the shift towards more managed care contracts and models for service delivery, now more than ever it is essential to support our claims with solid positive outcomes. Qualitative reviews of our therapy claims have increased in recent history. Therapy teams at Arbor Rehabilitation and Healthcare Services Inc. are prepared and ready to help their facilities succeed in this changing environment!