High therapy billings trigger audits: CMS

Several therapy associations Thursday called on Congress to permanently end Medicare Part B caps on physical, speech and occupational therapy by adding language to a funding measure expected next week.

Though Congress agreed in theory last year to remove hard limits, action fell to the wayside as Democrats and Republicans battled over a budget resolution — a fight that ultimately ended in a three-day government shutdown.

On Jan. 1, a two-year therapy caps exception expired and limits of $2,010 for physical and speech therapy combined and $2,010 for occupational therapy were reinstated. The Centers for Medicare & Medicaid held some therapy billings, but the agency began processing early January claims “first-come, first-served” on Jan. 25.

In a conference call coordinated by AARP Thursday, representatives for the American Occupational Therapy Association, the American Physical Therapy Association and others said clients are already being forced to pare back or cancel services because of out-of-pocket costs.

Overall, about one-sixth of the 6 million Medicare patients receiving therapy each year surpass the cap, experts said.

“There is a sense of urgency that Congress must act,” said Justin Elliott, vice president of government affairs for the American Physical Therapy Association. “If this drags on until March, we’re going to have more compounding problems.”

There is some hope for action, even as another budget vote looms.

House Republican leaders have said they want to attach funding for an expiring health program to a stopgap measure needed to keep the government open after Feb. 8.

Lawmakers used the same tactic Jan. 22 when they added six years worth of funding for the Children’s Health Insurance Plan to a short-term spending plan.

Bloomberg BNA reported that members of Congress are considering adding an extension for the federal community health centers program or several short-term Medicare “extenders” provisions. The cap repeal is included in one of three extender packages.

Such health measures could be used to attract votes for the next continuing resolution or in a final spending bill, Rep. Tom Cole (R-OK) said Jan. 30.

Heather Parsons, associate chief officer for federal affairs for the American Occupational Therapy Association, said the Congressional Budget Office put the current cost of doing away with therapy caps at $6.5 billion, a far cry from the $13 billion cost cited in years past.

“This is such an opportunity, and I’m not sure it’s going to come our way again,” she said.