decisionhealth Newsletters, Part B News - 2018 Issue 2 (February)
CMS releases payments exceeding therapy cap despite end of exclusion
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Article Overview
This article covers a CMS update affecting Medicare therapy claims submitted above the annual therapy cap during a period when the exception had expired. It is relevant to therapists, billing staff, compliance teams, and Medicare claims processors who need to monitor CMS payment handling changes and related provider guidance. The article discusses the timing of CMS’s rolling hold, the claims affected, and related notices from provider organizations.
Why This Topic Matters
The update can affect when therapy claims are paid or denied and requires providers to follow CMS communications during a temporary gap in the cap-exception policy. Understanding the article helps billing and compliance teams monitor claim status and align patient notice practices with current Medicare processing.
Article Sections
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CMS payment processing update
Overview of the CMS announcement and the affected therapy claims during the temporary policy gap.
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Background on the therapy cap exception
Context on the Medicare therapy cap, the expired exception, and the broader policy situation described in the article.
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Claim holding and release timing
Description of how CMS said it would sequence held claims and manage newly submitted claims over time.
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Provider guidance and related notices
Information on guidance from provider organizations and references to monitoring CMS notices for updated processing information.
What You Will Learn
- How CMS was handling therapy claims during the temporary policy change
- What operational issues the rolling hold created for providers and billers
- How provider organizations were advising members to monitor CMS communications
- What general Medicare payment-processing concerns were raised by the article
Who Should Read This
- Therapy providers
- Medical coders
- Billing staff
- Revenue cycle teams
- Compliance professionals
- Medicare claims processors
Modifiers Discussed
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