Now that most physical therapy practices are aware of Medicare’s upcoming Manual Medical Review process, everyone is scrambling to understand what they need to do in order to comply. A missing piece of information has been the exceptions process – what is it? how do you find out? what do you need to do?
Nancy Beckley, who runs one of our industry’s leading rehab compliance consulting firms, has just published the list of exceptions forms by Medicare contractor. To find out what form you need to complete, look up your Medicare contractor and link to their form. If you have problems directly linking, cut and paste the url into your browser. Your contractor may have updated information, so be sure to double check with them for updated information. Providers in Phase I (October 1, 2012) should prepared to submit requests after 9/17/2012 for those patients who are already at the $3700 threshold in order to get preapproval.
To quickly recap what we know about the Manual Review Process to date, and what you must do:
- Therapist need to identify what phase they are in, and when they need to begin complying to the new process.
- Beginning October 1st, all Medicare patients will need to have their new caps verified and begin tracking accordingly.
- If the patient has reached their new $3700 cap or is approaching the cap, an exceptions process form will need to be completed and submitted. If you do not hear back within 10 days, you are considered approved, although this does not guarantee payment.
- If a patient is approaching or has reached their cap, be sure to have the patient sign an ABN form.
Click here to learn more about the Manual Medical Review Process and what you need to know.
Clinicient is one of the only physical therapy EMR and practice management providers who is prepared for the Manual Medical Review process, and will be ready on October 1st to help their customers:
- Automatically identify and track what phase therapists are in with auto-lookup by NPI number
- Automatically track therapy caps, including the $1880 and $3700 caps
- Alert therapist and other staff of what is needed to comply with Medicare’s requirements
- Help therapists demonstrate medical necessity with functional and clinical goal tracking and flow sheets
- Ensure that the claim always matches the documentation, following all Medicare billing rules and eliminating audit risks
- Facilitate physician communication with automated POC alerts and certifications
- Provide and store electronic ABN forms for patient signature when needed