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  • RACs to Conduct Manual Medical Review of Claims Subject to Therapy Cap

    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.


    • Lets make this easier for all of us. Put an immediate cap on reimbursement $100. part a AND part b per session. Also , tell them to STOP paying for pallative or unsubstantiated treatment NOW. US per dx limited to 8 visits for example. Since it as NO place in treatment of the spine for instance it would curtail the billings from the offices ( not necessarily PT offices) that provide ineffective,mindless intervention for the sole purpose of creating a bill. Addtinally, choosing the right restrictions may foster more thought in some of our conscientious but misdirected PTs. Limiting US reimbursement is one of many examples we could employ to help with MC spending. This list may take an hour to compile and save millions, we could start tomorrow morning. The give back to us is NO CAP. Our intervention should be a cost saving intevention to our patient population. When MC realizes or is told that we may get the reimbursement and respect we deserve.

      Posted by tom DePaulis on 3/24/2013 5:33 PM

    • I don't know why government have hire Pts working against PTs? Waist of taxpayers moneys.

      Posted by Alex Khomennko on 3/26/2013 7:13 PM

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