Therapy Caps Expire Today

On Monday, the Bush administration announced that it would give Congress more time to deliberate on the proposed cut to physician payments by the Centers for Medicare and Medicaid Service (CMS). Originally scheduled to take effect today, CMS spokesman Jeff Nelligan said the agency “will not be making any payments on the 10.6 percent reduction until July 15, at the earliest.”

However, at a meeting with therapy provider groups late yesterday afternoon, the agency’s deputy administrator, Herb Kuhn, advised that the administrative payment relief CMS is providing for physicians does not extend to the Medicare therapy caps exceptions process.

This means that any outpatient therapy claims submitted as of today will begin to count against a beneficiary’s allowance of $1,810 per year for speech and physical therapy combined and another $1,810 for occupational therapy. Therapy provided in a hospital outpatient setting does not count against the caps.

Furthermore, CMS will count any therapy a beneficiary may have received since January 1, 2008 against the cap. This means that many beneficiaries will already have exceeded their annual cap, even though they obtained an exception from the cap at the time they received their therapy.

Kuhn suggested that therapy providers could hold claims and not submit them to CMS for the next 10 days, by which time we can hope that Congress will have reconvened and passed an extension of the therapy caps exceptions process.

At AAHSA, we’re encouraging our members to Contact Congress. You may also call the U.S. Capitol at (202) 224-3121 (not a toll-free call) and ask to be connected to your legislators.