Providers rip huge backlog of therapy claims reviews

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NASL's Cynthia Morton
NASL's Cynthia Morton

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

The reviews, which are supposed to be completed within 10 days, have been an ongoing problem. About a third of claims were awaiting processing at the time of the survey, which was commissioned by the National Association for the Support of Long-Term Care.

The American Health Care Association joined NASL in calling for a more streamlined system.

The manual medical review (MMR) process applies to Part B claims filed after a beneficiary has hit the $1,950 annual threshold for occupational therapy or the same limit for combined physical therapy/speech-language pathology services. 

The MMRs pose administrative and fiscal burdens, especially in 11 states that require the review prior to payment. 

Investigators found that less than one-fourth of the MMR claims for 2013 had been paid. One-third of the claims were still being processed, and another one-third already had been denied.

NASL Executive Vice President Cynthia Morton encouraged reform advocates to make their voices heard before the end of the year, when therapy caps and reviews were part of other legislative deals being considered.

The survey included eight NASL member organizations of various sizes, which provide therapy in various long-term care settings. 

The MMR process has faced fierce criticism since it began in Oct. 2012. The bungled implementation of the reviews sparked provider outrage and was described in a Government Accountability Office report released in July.