Rep. Boustany introduced our bill to permanently repeal the Medicare Therapy Cap in the House. Read more.
Considering an occupational therapy career? Get your questions answered, learn about OTs and OTAs, & find admissions criteria.
AOTA members can access all articles in the British Journal of Occupational Therapy and Canadian Journal of Occupational Therapy.
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Source: AOTA, Regulatory Affairs
Therapy Cap for OT
The amount will be adjusted incrementally based on the Medicare Economic Index (MEI), or Congressional action could repeal it entirely
(currently in place through March 31, 2015)
Could be extended further or repealed entirely along with the cap
Manual Medical Review (MMR)
MACs conduct medical reviews of all claims over $3,700 on a prepay basis; pre-authorization granted in 20-visit increments
RACs take over the reviews and states divided into prepay and post-pay
First quarter of 2014:
No change from 2013 - RACs review claims over $3,700 and states divided into prepay and post-pay
RAC reviews paused during procurement; when contracts are final reviews will begin on a post-pay basis for all states. All claims will be reviewed retrospectively – this is just temporary provider relief
No changes expected
Multiple Procedure Payment Reduction (MPPR)
50% of the practice expense (PE) component of the fee schedule formula for all second and subsequent codes billed on the same day, for the same patient, by the same NPI
No changes expected
Note: If the CPT codes used by OT are reformed and revalued in the coming years, the MPPR would no longer be applicable
G-codes and modifiers required on the claim form to receive payment beg. July 1, 2013 (first half of 2013 was a testing period)
Congressionally-mandated use of the CARE Tool to replace G-codes is a possibility
Physician Quality Reporting System (PQRS)
OTs in private practice eligible to report; failure to report in 2013 means a -1.5% penalty in 2015
OTs in private practice eligible to report; failure to report in 2014 means a -2% penalty in 2016
Measures revised by CMS each year in the MPFS final rule; a continued shift toward registries and other refinements is expected
Updated: April 2014