Therapy caps exceptions becoming too routine?
Briefings on Outpatient Rehab: Reimbursement and Regulations, March 1, 2009
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Although it may seem as though the Medicare therapy caps exceptions process has become a permanent fixture, the reality is that Congress and CMS are always looking for a better system. Enacted in 2006, the exceptions process enables Medicare beneficiaries to continue receiving the therapy services they need and allows therapy providers to continue billing for those services once the patient reaches the cap in almost all cases. The therapy caps for this year are $1,840 for PT and SLP services combined and $1,840 for OT. The exceptions process has been inclusive, and changes in 2007 made exceptions automatic for patients with comorbidities or conditions on the exceptions list. As a result, the therapy caps haven’t been the money saver CMS originally intended. But because of challenges from professional associations such as the American Physical Therapy Association (APTA), American Occupational Therapy Association (AOTA), and the American Speech-Language-Hearing Association (ASHA), Congress has continued to extend the exceptions process each year.
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