Medicare Therapy Cap Manual Medical Review: Meetings with CMS

APTA and other therapy stakeholders meet with the Centers for Medicare and Medicaid Services (CMS) on a monthly basis to discuss concerns and issues with the therapy cap and manual medical review. During these calls, often CMS will ask for examples of issues occurring with these processes. We encourage our members to fill out a complaint form or e-mail advocacy@apta.org so that we can share these concerns with CMS. Below are summaries of the information provided in meetings with CMS.

If you have questions about this information, please e-mail advocacy@apta.org.

  • Conference Call - June 4, 2013 (.pdf)

    During this call, discussion topics included the content of the ADR requests, challenges with the ADR submissions process, 10 business day turnaround time for review, content of RAC review results letters, and the RAC "discussion period." CMS asked providers to send in examples of incorrect/insufficient review results letters, issues with ADRs, and other information regarding implementation of manual medical review such as if the RAC is not meeting the 10-business day timeframe.

  • Conference Call - May 7, 2013 (.pdf)

    During this conference call, APTA and other therapy stakeholders discussed with CMS concerns and issues involving Advanced Beneficiary Notices (ABNs), the RAC reviews, ADRs, appeals, and future outreach planned. CMS asked therapy organizations to send in examples of RACs that are incorrectly implementing the review process.

  • Meeting - April 1, 2013 (.pdf)

    APTA along with other therapy stakeholder organizations met with CMS to discuss the implementation of the April 1 manual medical review process for outpatient therapy claims exceeding $3700. The main discussion topics included the RAC medical review administration, use of the Advanced Beneficiary Notice (ABN), and the implications of pre- and postpayment review.

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