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CMS outlines initial cap appeals plans

Rehab Private Practice Alert, February 1, 2006

In a letter to several members of Congress, Herb B. Kuhn, the director for the Center for Medicare Management, outlined plans for implementing a therapy cap exception process.

The letter stated the Centers for Medicare & Medicaid Services' (CMS) intentions to move quickly to create a plan once Congress officially passes the Deficit Reduction Act.

CMS is working on a plan while waiting for final word.

Kuhn wrote that CMS is exploring options that include automatic exceptions for specific individuals, written exceptions for need-based patients, and adjustments for any claims denied for services provided prior to implementation of the exceptions process.

The letter gave the following example of a case that might be eligible for an appeal: a closed head injury, or therapy relating to a broken arm in the same year that the patient received a hip replacement.

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