Manual Medical Review

Providers rip huge backlog of therapy claims reviews

Providers rip huge backlog of therapy claims reviews

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A provider-sponsored survey recently uncovered huge backlogs of therapy claim reviews for beneficiaries who exceeded the Medicare Part B caps limits.

CMS explains therapy cap notification requirement, but more guidance needed, NASL leader says

CMS explains therapy cap notification requirement, but more guidance needed, NASL leader says

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A recent Centers for Medicare & Medicaid memorandum provides some clarity regarding new therapy cap notification rules, but providers still need guidance on other aspects of therapy reimbursement, according to Cynthia Morton, executive vice president of the National Association for the Support of Long-Term Care.

Medically Complex Medicare Part B

Medically Complex Medicare Part B

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While CMS tries to figure out how to proceed with the manual medical review process, we continue to track our caps and apply our modifiers. In the meantime, has anyone noticed how our typical Medicare Part B patients have become more medically complex than just a few years ago?

MedPAC recommends lowering outpatient therapy caps by 33%

MedPAC recommends lowering outpatient therapy caps by 33%

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Already contentious Medicare Outpatient Part B therapy caps would likely receive even more attention if the Medicare Payment Advisory Commission has its way. MedPAC recommended Thursday that Congress drop the annual allowable limits from $1,880 to $1,270.