Medicare only pays for therapy services that are demonstrated reasonable and medically necessary. However, Medicare not only caps payments, but when a beneficiary’s treatment reaches a $3700 annual threshold, therapy claims may go through an audit process known as Manual Medical Review (MMR).
Sounds complex and confusing? It can be— unless you have a system like Clinicient. Clinicient helps guide you through Medicare guidelines for physical therapy, occupational therapy and speech enabling you to:
The results? With Clinicient, you’re notified—and prepared—to keep on top of Medicare therapy caps, manual medical review and other requirements.
Minimize your compliance risk and financial exposure with automated compliance management tools that take the guesswork out of following Medicare guidelines for physical therapy, occupational and speech therapy.
In 2016 the Medicare Part B outpatient therapy cap for Occupational Therapy is $1,960 and the combined cap for Physical Therapy and Speech-Language Pathology services is $1,960.
Exceptions to the therapy cap are allowed for reasonable and necessary therapy services. However, services above $3,700 for PT and SLP services combined and/or $3,700 for OT services may be subject to manual medical review.
Manual medical reviews are performed by Recovery Audit Contractors, commonly known as RAC auditors. RAC auditors identify and recover improper Medicare payments paid to healthcare providers under fee-for-service Medicare plans.
Failure to understand and adhere to the CMS rules and regulations and establish medical necessity in your clinical documentation increases your audit risk and will have a serious impact on Medicare reimbursements.
Learn how Clinicient can help you simplify manual medical review with PT Jerry Henderson.