The Centers for Medicare and Medicaid Services (CMS) has posted a list on its website assigning providers to 1 of 3 phases for manual medical review when outpatient therapy services exceed $3,700. The list identifies phase I and phase II providers by their National Provider Identifier; those who do not appear on the list are included in phase III. The phases delineate the time frames during which the providers would be required to obtain advanced approval from their Medicare Administrative Contractor (MAC) in order to receive coverage for outpatient therapy services beyond $3,700.
- Phase I providers: Subject to manual medical review October 1-December 31, 2012.
- Phase II providers: Subject to manual medical review November 1-December 31, 2012
- Phase III providers: Subject to manual medical review December 1-December 31, 2012.
Additional information regarding the therapy cap and the manual medical review process is available on APTA's website. CMS also provides a fact sheet and question-and-answer document regarding the process. MACs are expected to issue additional information about the process in the near future.
Will physical therapists be performing the manual medical records reviews?
Posted by David W. Clifton,PT
on 8/24/2012 7:56 PM
APTA will record a call with reimbursement chairs on September 5 that will address the therapy cap. The recording will be posted on www.apta.org. News Now will provide a link to the recording, which will be free to members, when it is available.
There is no requirement that therapists conduct the manual medical reviews for outpatient therapy services. Reviews could be conducted by nurses or other health care providers.
Posted by News Now Staff
on 8/27/2012 3:43 PM
Questions:
The provider assignment is specific to individual NPI only - correct? My personal NPI is assigned to Phase 2, but my clinic NPI is not listed... which could be interpreted as automatic assignment to Phase 3, or as simply N/A.
Are all clinicians within a specific practice assigned to the same phase? And if not - what if two PTs share a patient but receive different phase assignments?
Posted by Shannon Murphy, MPT
on 8/31/2012 4:10 PM
Is there a specific format to submit a request for an exception?
Posted by Dr Peter J Vilasi MPT DPT
on 9/4/2012 9:40 PM