The Centers for Medicare and Medicaid Services (CMS) has begun to automatically reprocess a large volume of claims paid to physical therapists and other providers under the 2010 physician fee schedule because the fees were affected by some provisions with retroactive dates that were included in the Affordable Care Act passed last year. For therapy services, most of the claims have resulted in increases in payment of about 50 cents.
Recently, CMS sent a notice informing providers that the agency has had difficulties when reprocessing claims involving therapy services. The challenge occurs when the KX modifier was not used because the patient had not reached the therapy cap, but subsequently the patient received therapy services beyond the cap. In these instances, the claims adjustments were rejected and CMS was seeking recoupment from the providers for the original claims. To prevent this from occurring, CMS announced it will no longer automatically reprocess claims involving services subject to the cap. However, providers may request contractors to reprocess these therapy claims.