APTA along with other therapy stakeholder organizations met with the Centers
for Medicare and Medicaid Services (CMS) to discuss implementation of the
manual medical review (MMR) process for outpatient therapy claims exceeding
$3,700. As reported March 22 in News Now, recovery audit
contractors (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
assured stakeholders that the agency would have the necessary safeguards in
place to ensure appropriate and fair medical review by RACs. Prior to the
meeting, the therapy organizations sent a detailed list of questions to CMS
regarding the use of the advanced beneficiary notice (ABN), RAC administration,
and outreach education to Medicare contractors, providers, and patients. CMS
indicated that it plans to issue a written FAQ of the questions submitted in
the coming weeks.
the meeting, CMS clarified the following:
the coming days, APTA will provide additional resources to members on the application
of the 2013 MMR process. Resources and the latest information on the therapy
cap can be found on APTA's 2013 Medicare Changes webpage.
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