Medicare Compliance & Reimbursement

Prepare for $1,810 limit starting July Congress placed a moratorium on Medicare's 2008 therapy cap until June 30, but that doesn't mean you should avoid learning about this year's cap features. Effective July 1 (when the moratorium expires), occupational therapy services will be subject to a $1,810 Medicare limit, while combined physical therapy and speech-language pathology reimbursement will face a separate $1,810 cap. Therefore, if your physical therapist treats a patient on July 10 and you bill $800, and a speech-language pathologist treats the patient on Aug. 1 and bills $600, the patient will only be allowed another $410 in PT/SLP benefits for the remainder of 2008, but the patient would still have $1,810 in Medicare reimbursement available for occupational therapy services. Exception: In some cases, the therapist may administer services that aren't subject to the Medicare payment cap because they are included on the therapy cap "exceptions" list. For these procedures, Medicare will automatically process the claims without counting the payments toward the cap. To read more about the therapy cap, visit CMS' MLN Matters site at http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5871.pdf.