Home Health & Hospice Week

Don't forget you can't use the manual exceptions process--at least for now.

If you furnish Part B therapy, you need to master the newly revised therapy cap exceptions process or risk losing your rightful reimbursement.

Right after the Centers for Medicare & Medicaid Services released updates to the therapy cap ex-ceptions process last November, the agency turned around a month later and put a new spin on things by declaring that the manual exceptions process no longer exists (see Eli's HCW, Vol. XVI, No. 2).

The exceptions is now "entirely automatic" as of Jan. 1, 2007, CMS says in Dec. 29, 2006 Transmit-tal 1145.

The good news: The automatic process hasn't changed, so you don't need to learn any new steps.

Other good news is, if you believe a patient requires further skilled therapy and that the patient will be able to show significant improvements, you no longer have to go through all the work of submitting records, writing a justification letter, etc., points out physical therapist Rick Gawenda, director of physical medicine and rehabilitation at Detroit Receiving Hospital.

The bad news: "This puts more onus on the therapy provider to make sure the documentation is there" to support the automatic exception, Gawenda adds. But a recent CMS transmittal helps providers know how to document correctly, he says.

Only temporary? CMS nixed the manual exceptions process this year because not many therapy providers appeared to be using it. If the agency finds therapists really need the manual process, however, CMS might bring it back, industry experts hope.

For now: Take another look at the latest list of acceptable ICD-9 codes for the automatic exception. Because it did away with the manual process, CMS updated the ICD-9s and complexities to a more comprehensive list that hopefully will cover much of what the manual process used to cover.

Note: For a list of the ICD-9 codes that qualify a patient for the exception, email editor Rebecca Johnson with "Therapy Cap Codes" in the subject line.