Advance Beneficiary Notice and Therapy Caps Clarification [05-01-13]

Filed under: Industry Updates — Editor @ 9:34 am

During the recent meeting of trade associations and other stakeholders with representatives from the Centers for Medicare and Medicaid Services Provider Compliance Group, the use of Advance Beneficiary Notice (ABN) to notify beneficiaries of the therapy caps and thresholds was discussed. There has been a change in the use of the ABN effective January 1, 2013 as a result of the American Taxpayer Relief Act (ATRA). When the therapy threshold was introduced in 2012, providers were instructed to issue the ABN to a beneficiary who was exceeding the threshold and if the claim was denied, the beneficiary could be held liable. As a result of the ATRA, beneficiaries are now protected from liability. The ABN should not be used for situations involving the exceeding of the therapy cap and/or threshold. If the therapy claim is denied, it will be provider responsibility only. ABNs should be used as they have traditionally been used such as when the provider has physician’s orders to provide services the provider believes will not be covered by Medicare.

National Healthcare Decisions Day [04-15-13]

Filed under: Industry Updates — Editor @ 4:08 pm

nhddApril 16, 2013 is National Healthcare Decisions Day. The goal of the day is to encourage Americans to think and talk about their health care goals and communicate their health care decisions by executing advance health care directives.  Studies indicate that most Americans have not executed documents that name a health care decision-maker or a living will declaration to express their wishes for their end-of-life care. As a result, families and health care providers regularly struggle when forced to make difficult health care decisions in a crisis in the absence of guidance from the patient. These stressful moments can be eased if individuals execute advance health care directives or living will declarations and appointments of health care representatives or health care powers of attorney. (more…)

A New Way To Measure Pain [04-11-13]

Filed under: Industry Updates — Editor @ 11:15 am

fMRI ScanScientists reported Wednesday that they had developed a way to measure how much pain people are experiencing by scanning their brains. The researchers hope the technique will help doctors treat pain better, but the work is also raising concerns about whether the technique might interfere with doctors simply listening to their patients.  Now, when someone is in pain, a doctor has no way to judge its severity except to ask questions, a method that often is inadequate. (more…)

CMS Issues Guidance on the Manual Medical Review Process for Therapy Claims Over the $3,700 Threshold [03-22-13]

Filed under: Industry Updates — Editor @ 2:41 pm

cmsannouncementLast night, CMS updated the Manual Medical Review page on their website, following is the is the posted update (click here to be directed to the CMS webpage). The American Taxpayer Relief Act of 2012 (ATRA) was signed into law by President Obama on January 2, 2013. This law extends the Medicare Part B Outpatient Therapy Cap Exceptions Process through December 31, 2013. Section 603 of this Act contains a number of Medicare provisions affecting the outpatient therapy caps and manual medical review (MR) threshold.  (more…)

Manual Medical Review Process Update from CMS [02-22-13]

Filed under: Industry Updates — Editor @ 12:26 pm

cmslog4colCMS has posted an update regarding the Manual Medical Review (MMR) process to the Medical Review and Education page on the Therapy Cap (click here to be redirected to the page). Here is a portion of the update:  CMS is developing a long term strategy to deal with manual medical review. However, in the interim, Medicare Administrative Contractors (MACs) will conduct prepayment review on the claims reaching the $3700 threshold. CMS requested MACs conduct these manual medical reviews within 10 days. At this time, there is no advance request for an exception process. Additional information will be provided on the MAC websites. Section 603 (b) of the American Tax Relief Act counts outpatient therapy services furnished in a Critical Access Hospital (CAH) toward a beneficiary’s annual cap and threshold amount using the Medicare Physician Fee Schedule rate. CAHs are not subject to the therapy cap, the manual medical review process, or the use of the KX modifier. (more…)

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