Home Health & Hospice Week

One HHH Medicare Administrative Contractor is lending a helping hand in figuring out the new therapy cap exceptions process for Part B therapy that starts Oct. 1.

Suppliers and providers who plan to provide services above the $3,700 threshold for occupational therapy or physical and speech therapy combined "will need to submit these services for prior authorization," Palmetto GBA says in a new job aid on the topic. "Claims for services in excess of this threshold that have not been not pre-authorized will be subject to pre-payment medical review." (See Eli's HCW, Vol. XXI, No. 31 for more details about the new review process.)

Remember: The caps apply to Part B outpatient therapy only, not to therapy provided under a home health plan of care -- even if CMS did recently send cap letters to beneficiaries receiving home care therapy.

You may not have to deal with the manual review process quite yet, though, Palmetto reminds providers. CMS is phasing in the process in three steps, with the last phase beginning Dec. 1.

Resource: For a free copy of and link to Palmetto's lengthy job aid, e-mail editor Rebecca Johnson at rebeccaj@eliresearch.com with "Thera-py Review Job Aid" in the subject line.