CMS announced last evening that as of April 1, recovery audit contractors (RACs) will conduct manual medical review (MMR) of outpatient therapy services, including physical therapy, for outpatient therapy claims that exceed $3,700.
In the additional guidance on MMR released last night, CMS said that RACS will complete 2 types of review for claims processed on or after April 1, 2013—prepayment review for states within the Recovery Audit Prepayment Review Demonstration, and immediate postpayment review for the remaining states.
APTA is gathering additional information regarding this MMR policy to further inform members. In addition, APTA will meet with CMS officials and Congress to address concerns about the challenges this process will present for both providers and patients. For continued updates on this and other changes to Medicare policy occurring this year, visit APTA's 2013 Medicare Changes website.
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