MedPAC recommends lowering outpatient therapy caps by 33%

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MedPAC recommends lowering outpatient therapy caps by 33%
MedPAC recommends lowering outpatient therapy caps by 33%

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.

The group voted unanimously to reform the caps, one of which is for occupational therapy, and the other is for physical and speech-language therapy combined. Most skilled nursing residents are currently shielded from the caps under an umbrella exceptions process, but that provision is set to expire at the end of the year.

MedPAC also recommended the introduction of a manual medical review process for all requests that exceed one of the caps; permanently including services delivered in hospital outpatient departments under the caps; and reducing the practice expense payment by half when multiple therapies are provided to the same patient on the same day.

The commission said the changes would ensure the program “integrity” of outpatient therapy services and ensure access to outpatient therapy services in the longer term.

MedPAC is required by the Affordable Care Act to report recommendations for outpatient therapy changes to Congress by June 15, 2013.

For more on MedPAC's recommendations, see the slide presentation attached above.

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