Eli's Rehab Report

Published on Sun Oct 17, 2010 PDF

Question: I am trying to verify the information from a News Brief in Eli's Rehab Report, Vol. 16, No. 8, titled "Check Out This Therapy Cap Freebie." In short, the article described that Medicare claims between January and April of 2009 would not be counted toward the therapy caps because of a delay in implementing updated claims processing info. The article emphasized this affects

ALL providers, regardless of the fact that the news was cited from Cahaba GBA's regional home health intermediary news site.

I tried to find a reference to this on my FI's Web site, and I can't find anything. I also looked on the CMS Website and had no luck either. Do you have further information on this? Are you sure that this wasn't just a home health-related billing issue?

-- Texas Subscriber.

Answer: The news article we referenced in the issue you referred to attests that this "therapy cap freebie" affects all providers -- not just those doing home health rehab. Cahaba's home health news as the only source of this information is curious, however. Plus, the fact that your Medicare contractor and the CMS Web site do not mention this rather major claims processing issue for therapy caps is rather surprising.

To further validate, additional experts at the American Physical Therapy Association verified that this does affect all therapy providers. Essentially, CMS was not tracking the therapy caps for anyone between Jan. 1, 2009-April 2009.

Action: If you continue to notice problems with your claims during that time period, contact your Medicare contractor. You might also contact a representative at your professional association for further guidance on how to claim your proper reimbursement for those months.

-- Reader Questions were answered or reviewed by Rick Gawenda, PT, director of PM&R at Detroit Receiving Hospital and President/CEO of Gawenda Seminars & Consulting.