tci Medicare Compliance & Reimbursement - 2006 Issue 4

OUTPATIENT THERAPY: Therapy Caps Tied To Spending, Payment Update

Therapy caps reduce provider spending but threaten to escalate benes' out-of-pocket burdenUpon recommendation from the Government Accountability Office, therapy caps went back into effect Jan. 1, 2006, at $1,740 per bene. The $1,740 limit applies to OT services and to PT and SLP services combined.There are notable ebb-and-flow relationships between therapy caps and therapy spending, a recent Medicare Payment Advisory Commission report reveals. When therapy caps were imposed in 1999, Part B therapy spending decreased 34 percent. The number of therapy users decreased, with eight percent of benes exceeding the caps. When the moratorium went into...

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