Here We Go Again

In a scenario that is all too familiar to many therapy providers, the clock has run out on the therapy cap exceptions process and the manual medical review process, which are both set to expire at midnight tonight (3/31/15). We were encouraged on Thursday after the House passed legislation which would have avoided the 21% cut in Medicare payments and extended the therapy cap exceptions process. Unfortunately, the Senate adjourned on Friday for its two-week spring recess without taking up the bill.  The general opinion seems to be that the bill will pass, and President Obama has stated that he will sign a bipartisan bill once it reaches his desk.  Nevertheless, we are in a state of limbo until the Senate reconvenes on April 13th.

This isn’t the first time that we have seen a deadline pass without legislation being enacted in time to prevent the hard cap from going into effect. In 2010, therapy providers went months without an exceptions process, only to have it applied retroactively to allow coverage during the period for which the exceptions process had expired. Furthermore, under current law, CMS’s electronic claims are not paid sooner than 14 calendar days (29 days for paper claims) after the date of receipt which will allow Congress an opportunity to work out the details and vote on the bill once they return from the recess.

The APTA has been advocating for a complete repeal of the therapy caps, and this delay creates an opportunity for additional advocacy efforts to take place.  Even if a complete repeal isn’t included in the final bill, an extension of the exceptions process will almost certainly be included and if precedence is any indication, the provision for therapists to use the KX modifier for claims for medically necessary services above the therapy cap will be allowed retroactively to April 1st. Therefore, it may be advisable for providers to hold claims for Medicare beneficiaries who have exceeded or will exceed the therapy cap over the next couple of weeks in order to give Congress time to finalize the legislation and for CMS to apply the changes.

We will provide more information as it becomes available. Stay tuned.