Medicare Changes Coming
Timely Claim Filing and Therapy Cap Exceptions
Last month President Obama signed into law the Patient Protection and Affordable Care Act (PPACA), which resulted in some important changes to Medicare rules. The Centers for Medicare and Medicaid Services (CMS) is announcing the changes that have the most immediate impact, and will continue to provide notice as implementation rules are developed. Following are two of the changes that have the most immediate impact on physicians:
Time Limit for Submitting Claims
Medicare fee-for-service claims with dates of service on or after January 1, 2010, must be submitted within one calendar year of the date of service. Claims with dates of service before October 1, 2009, must follow the pre-PPACA timely filing rules. Claims with dates of service from October 1, 2009, through December 31, 2009, must be submitted by December 31, 2010.
The following chart has been provided for easy reference:
DATE OF SERVICE FILING DEADLINE
10/01/2008 to 09/30/2009 12/31/2010
10/01/2009 to 12/31/2009 12/31/2010
01/01/2010 and after One year from date of service
Extension of Therapy Cap Exceptions Process:
The new law also extends the exceptions process for outpatient therapy caps through December 31, 2010. Under the exceptions process, which was originally enacted in 2006, Medicare will continue to pay for therapy services in excess of the cap if the services are deemed to be medically necessary. Outpatient therapy service providers may continue to submit claims with the KX modifier, when an exception is appropriate, for services furnished from January 1, 2010, through December 31, 2010.
The therapy caps were designed to put a limit on Medicare reimbursement for therapy services. In 2010, this limit is $1,860 for physical therapy and speech language pathology combined and $1,860 for occupational therapy. Deductible and coinsurance amounts applied to therapy services count toward the cap.
CMA will provide additional updates as they become available.
Contact: Michelle Kelly, 213/226-0338 or mkelly@cmanet.org
